The Japanese government incentivizes doctors to avoid prescribing antibiotics for certain ailments, but would the same approach work in the U.S.?
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This is the fifth and final story in a series about antibiotic use in Japan and the U.S. I've explored how a Japanese program reduces antibiotic misuse while also unpacking the factors that drive that misuse in the first place. Now, I'll examine whether the context in the U.S. is similar enough to Japan that lessons from one country can carry over to the other.
When penicillin was first introduced to the public, it earned the nickname "the wonder drug" because it cured infections that had once been deadly. It ushered in the golden era of antibiotics, during which the bacteria-killing drugs entered widespread use, driving down rates of severe disease and death from infections.
Unfortunately, the sweeping adoption of these medicines also set the stage for their obsolescence. Once hailed as miracles, antibiotics are now losing their power as bacteria evolve strategies to evade them.
Today, the world is contending with a "silent pandemic" of antibiotic resistance, driven largely by the misuse and overuse of these critical medicines. Curbing resistance, then, means changing how doctors prescribe — and patients use — antibiotics.
I traveled to Japan because a government initiative aimed at correcting antibiotic misuse has helped slash unnecessary prescribing and I wondered if a similar approach could work in the U.S. The program offers "tips" of 800 yen (about $5) to the clinics of pediatricians and ear, nose and throat doctors (ENTs) who withhold antibiotics in cases when they're likely not needed.
My findings suggest that many of the factors that drive antibiotic misuse in outpatient clinics overlap in the U.S. and Japan. But the cultural, governmental and insurance landscape may differ too greatly between the two countries for America to copy-and-paste Japan's approach. Instead, here's what I think could work to close the gaps in antibiotic overprescription in the U.S., based on my conversations with doctors.
In both Japan and the U.S., sick visits are mere minutes long, so doctors must determine quickly whether an antibiotic is needed. Few rapid tests exist for bacterial infections, introducing a degree of diagnostic uncertainty. Children's caregivers sometimes request antibiotics when they're not needed, and depending on the doctor, that social tension can be enough to prompt an unnecessary prescription, research has found.
I learned that children's caregivers value doctors who can answer questions and clearly explain their reasoning. They don't necessarily arrive at an appointment expecting a specific "solution," such as an antibiotic prescription — even if they sometimes request one. When faced with parents who request a prescription, doctors can often defuse the tension by explaining why antibiotics aren't necessary, my reporting found.
In Japan and the U.S., children's caregivers value doctors who can explain their rationale for opting for one treatment course over another.
On paper, Japan's antibiotic incentive gets at both halves of this pediatrician-parent dynamic. It offers pediatricians and ENTs extra payment to avoid antibiotics for certain types of infections. To claim that cash for their clinics, the doctors must explain their reasoning for withholding antibiotics to the child's caregivers, to help educate them about appropriate antibiotic use.
Although the pressures that lead to overprescription are similar in the U.S., the countries have several big differences.
For one, Japan has a national insurance system in which children's healthcare is essentially free. People in Japan report a relatively high degree of trust in their national government overall, and they specifically report being very happy with their healthcare system, with satisfaction rates far exceeding those of similarly wealthy countries.
By contrast, the U.S. has a patchwork of private, subsidized and public insurance. About 27 million people — roughly 8% of the population — are uninsured, and those with insurance frequently face issues with using their coverage and major barriers to care, such as prior authorization and claim denials. Navigating these barriers can derail and delay medical care, spurring frustration. Meanwhile, the number of people able to cover medical care is falling as costs spike, and people worry that insurers hold too much sway over health policy.
