Background Growing rates of antibiotic resistance, caused by increasing antibiotic use, pose a threat by making antibiotics less effective in treating infections. Objective We aimed to study whether physicians working at privately and publicly owned health centres differed in the likelihood of prescribing antibiotics and choosing broad-spectrum over narrow-spectrum antibiotics. Methods To estimate the effect of ownership on the probability of a prescribed drug being an antibiotic, we analysed all 4.5 million prescriptions issued from 2011 to 2015 at primary health centres in Västerbotten, Sweden. We controlled for patient age, sex, number of prescriptions per patient, and month of prescription, and used a maximum likelihood logit estimator. We then analysed how ownership affected the likelihood of a prescribed antibiotic being broad spectrum. We also used aggregated data to estimate the impact of the number of private health centres on the number of antibiotic prescriptions per inhabitant and the proportion of broad-spectrum antibiotics. Results Holding other factors constant, private physicians were 6% more likely to prescribe antibiotics and 9% more likely to choose broad-spectrum antibiotics. An increase by one additional private health centre was positively associated with an increase in the number of antibiotic prescriptions per inhabitant and a higher proportion, although not significant, of broadspectrum antibiotic prescriptions. Conclusion Our findings suggest that private physicians prescribe more antibiotics, especially broad-spectrum antibiotics, than public physicians. Therefore, it is crucial to provide health centres with incentives to follow guidelines for antibiotic prescription, especially when the level of private provision of primary healthcare is high.

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Appropriate use of antibiotics is an important strategy to combat the problem of growing antibiotic resistance rates. In order to follow this strategy, it is important to understand the determinants of antibiotic use. We analyse the potential link between competition among general practitioners (GPs) measured with the Herfindahl-Hirshman index (HHI) and regional antibiotic consumption in Norway in 2015 and 2016. We use the data about antibiotic consumption expressed by the number of prescriptions of antibiotics for systemic use (J01) and by the number of antibiotics for respiratory tract infections (phenoxymethylpenicillin (J01CE02), doxycycline (J01AA02), amoxicillin (J01CA04) and macrolides (J01FA)) per 1000 inhabitants. We apply multiple regression analysis to the data mentioned above and control for socioeconomic characteristics of the municipalities. Our findings suggest that competition may contribute to about 37-80 additional antibiotic prescriptions per 1000 inhabitants per year and 23-46 additional prescriptions per 1000 inhabitants of antibiotics for respiratory tract infections. Moreover, our estimations suggest that antibiotic prescription is significantly related to the average number of consultations per patient, the average length of the patient list, travel time to a pharmacy, income, and the share of women.