Coast J, Smith R D, Millar M R
Department of Social Medicine, University of Bristol, UK.
Soc Sci Med. 1998 Jan;46(1):29-38. doi: 10.1016/s0277-9536(97)00132-9.
Resistance to antimicrobial drugs is increasing worldwide. This resistance is, at least in part, associated with high antimicrobial usage. Despite increasing awareness, economists (and policy analysts more generally) have paid little attention to the problem. In this paper antimicrobial resistance is conceptualised as a negative externality associated with the consumption of antimicrobials and is set within the broader context of the costs and benefits associated with antimicrobial usage. It is difficult to determine the overall impact of attempting to reduce resistance, given the extremely limited ability to model the epidemiology of resistant and sensitive micro-organisms. It is assumed for the purposes of the paper, however, that dealing with resistance by reducting antimicrobial usage would lead to a positive societal benefit. Three policy options traditionally associated with environmental economics (regulation, permits and charges) are examined in relation to their potential ability to impact upon the problem of resistance. The primary care sector of the U.K.'s National Health Service provides the context for this examination. Simple application of these policies to health care is likely to be problematic, with difficulties resulting particularly from the potential reduction in clinical freedom to prescribe when appropriate, and from the desire for equity in health care provision. The paper tentatively concludes that permits could offer the best policy response to antimicrobial resistance, with the caveat that empirical research is needed to develop the most practical and efficient system. This research must be conducted alongside the required epidemiological research.
全球范围内对抗菌药物的耐药性正在增加。这种耐药性至少部分与抗菌药物的高使用量有关。尽管人们的认识不断提高，但经济学家（以及更广泛意义上的政策分析师）对这个问题关注甚少。在本文中，抗菌药物耐药性被概念化为与抗菌药物消费相关的负外部性，并置于与抗菌药物使用相关的成本和收益的更广泛背景下。鉴于对抗药和敏感微生物的流行病学进行建模的能力极其有限，很难确定试图降低耐药性的总体影响。然而，出于本文的目的，假定通过减少抗菌药物使用来应对耐药性将带来积极的社会效益。本文考察了传统上与环境经济学相关的三种政策选择（监管、许可证和收费）对耐药性问题的潜在影响能力。英国国民医疗服务体系的初级医疗部门为此次考察提供了背景。将这些政策简单应用于医疗保健可能会出现问题，特别是可能会因适当处方的临床自由度降低以及医疗保健提供中的公平性需求而产生困难。本文初步得出结论，许可证可能是应对抗菌药物耐药性的最佳政策选择，但需要进行实证研究以开发最实用和高效的系统。这项研究必须与所需的流行病学研究同时进行。
