The effect of temporary parental benefit on children’s antibiotics use: Evidence from a natural field experiment

Linnea Wickström Östervall, Annika Hahlin, Astrid Lundevall


Prudent use of antibiotics is important to delay the spread of resistance. This paper analyses the effect on children’s antibiotics use of a reform of the temporary parental benefit in Sweden. The reform increased the maximum compensation for this benefit. The level of compensation for social security may affect the propensity of a patient or parent to push for a prescription for antibiotics, as a less generous compensation makes it more expensive to be absent from work and since there is widespread overconfidence in the effectiveness of antibiotics. Using municipality level data, we show that the reform resulted in a reduction in children’s antibiotics use by about five per cent. The result is fairly robust to alternative empirical strategies, suggesting that welfare policies can have important indirect effects that should be taken into account.


antibiotics use; social security; temporary parental leave; natural experiment; resistance

Full Text:



André, M., Vernby, A., Berg, J., Lundborg, C., 2010. A survey of public knowledge and awareness related to antibiotic use and resistance in Sweden. The Journal of Antimicrobial Chemotherapy, 65(6), 1292-1296

Barbosa, T.M., Levy, S.B., 2000. The impact of antibiotic use on resistance development and persistence. Drug Resistance Updates: Reviews and Commentaries in Antimicrobial and Anticancer Chemotherapy, 3(5), 303-311

CDC, US Department of health and human services, 2013. Threat Report 2013: Antibiotic resistance threats in the United States, 2013. CS239559-B, available at

Fredriksson, P., Holmlund, B., 2006. Improving Incentives in Unemployment Insurance: A Review of Recent Research. Journal of Economic Surveys, 20(3), 357-386

Fogelberg, S., 2013. Competition and Antibiotics Prescription. IFN Working Paper No. 949

Hall, C., Hartman, L., 2010. Moral hazard among the sick and unemployed: evidence from a Swedish social insurance reform.” Empirical Economics, 39(1), 27-50

Henricson, K., Melander, E., Mölstad, S., Ranstam, J., Hanson, B.S., Rametsteiner, G., Stenberg, P., Melander, A., 1998. Intra-urban variation of antibiotic utilization in children: influence of socio-economic factors. European Journal Of Clinical Pharmacology, 54(8), 653-657

Johansson, P., Palme, M., 2005. Moral Hazard and Sickness Insurance. Journal of Public Economics, 89(9/10), 1879-1890

Krueger, A., Meyer, B., 2002. Labor Supply Effects of Social Insurance. In A. Auerbach and M. Feldstein (eds.), Handbook of Public Economics, vol. 4 (pp. 2327-2392), North- Holland, Amsterdam

Little, P., Williamson, I., Warner, G., Gould, C., Gantley, M., Kinmonth, A., 1997. Open randomised trial of prescribing strategies in managing sore throat. BMJ: British Medical Journal (International Edition), 314(7082), 722-727

Little, P., Rumsby, K., Kelly, J., Watson, L., Moore, M., Warner, G., Fahey, T., Williamson, I., 2005. Information Leaflet and Antibiotic Prescribing Strategies for Acute Lower Respiratory Tract Infection A Randomized Controlled Trial. JAMA: Journal of the American Medical Association, 293(24), 3029-3035

Mainous, A.G., Zoorob, R.J., Oler, M.J., Haynes, D.M., 1997. Patient knowledge of upper respiratory infections: implications for antibiotic expectations and unnecessary utilization. Journal of Family Practice, 45(1), 75-83

Neumark, T., Mölstad, S., Rosén, C., Persson, L., Törngren, A., Brudin, L., Eliasson, I., 2007. Evaluation of phenoxymethylpenicillin treatment of acute otitis media in children aged 2-16. Scandinavian Journal of Primary Health Care, 25(3), 166-171

Pettersson-Lidbom, P., Skogman Thoursie, P., 2013. Temporary Disability Insurance and Labor Supply: Evidence from a Natural Experiment. Scandinavian Journal of Economics, 115(2), 485-507

Statistics Sweden. 2013. Statistical database, available online at:

Swedish Social Insurance Agency. 2007. VAB – Vård Av Barn. Tillfällig föräldrapenning 1974–2006, Redovisar 2007:10

WHO, (2001), WHO Global Strategy for Containment of Antimicrobial Resistance, available at:

WHO, homepage accessed April 14th 2014 at 9 am GMT+1:

Williamson, I., Rumsby, K., Benge, S., Moore, M., Smith, P., Cross, M., Little, P., 2007. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA: Journal of the American Medical Association, 298(21), 2487-2496

Ziebarth, N.R., Karlsson, M., 2010. A Natural Experiment on Sick Pay Cuts, Sickness Absence, and Labor Costs. Journal of Public Economics, 94(11/12), 1108-1122

Ziebarth, N.R., Karlsson, M., 2014. The Effects of Expanding the Generosity of the Statutory Sickness Insurance System. Journal of Applied Econometrics, 29(2), 208-230


E-ISSN 2038-1379 -  2009-2023 University of Perugia