Foxman B, Valdez R B, Lohr K N, Goldberg G A, Newhouse J P, Brook R H
J Chronic Dis. 1987;40(5):429-37. doi: 10.1016/0021-9681(87)90176-7.
Little is known about how generosity of insurance and population characteristics affect quantity or appropriateness of antibiotic use. Using insurance claims for antibiotics from 5765 non-elderly people who lived in six sites in the United States and were randomly assigned to insurance plans varying by level of cost-sharing, we describe how antibiotic use varies by insurance plan, diagnosis and health status, geographic area, and demographic characteristics. People with free medical care used 85% more antibiotics than those required to pay some portion of their medical bills (controlling for all other variables). Antibiotic use was significantly more common among women, the very young, patients with poorer health, and persons with higher income. Use of antibiotics for viral, viral-bacterial, and bacterial conditions did not differ between free and cost-sharing insurance plans, given antibiotics were the treatment of choice. Cost sharing reduced inappropriate and appropriate antibiotic use to a similar degree.
关于保险的慷慨程度和人口特征如何影响抗生素使用的数量或合理性，我们所知甚少。利用来自美国六个地点的5765名非老年人的抗生素保险理赔数据，这些人被随机分配到不同费用分摊水平的保险计划中，我们描述了抗生素的使用如何因保险计划、诊断和健康状况、地理区域以及人口特征而有所不同。享受免费医疗的人群使用的抗生素比那些需要支付部分医疗费用的人群多85%（控制所有其他变量）。抗生素的使用在女性、幼儿、健康状况较差的患者以及收入较高的人群中明显更为普遍。对于病毒、病毒 - 细菌和细菌感染情况，无论保险计划是免费还是需要分摊费用，只要抗生素是首选治疗方法，其使用情况并无差异。费用分摊在相似程度上减少了不适当和适当的抗生素使用。
