Report Finds Wide Variation in Unnecessary Antibiotic Prescribing for NYS Medicaid Patients

An analysis of potentially inappropriate antibiotic prescribing patterns among New York State's Medicaid population, released today by United Hospital Fund's Medicaid Institute, found wide variations in prescribing rates based on patient age, gender, race/ethnicity, county of residence, and individual insurance plans.

The report, The Right Prescription: Assessing Potentially Inappropriate Use of Antibiotics Among New York's Medicaid Population, funded by the New York State Department of Health, reviewed antibiotic prescriptions for Medicaid beneficiaries ages 18 to 64 who were diagnosed with acute respiratory infections (ARIs) between 2011 and 2015. These infections, such as acute bronchitis or the common cold, are usually caused by viruses, which do not respond to antibiotics. The inappropriate use of antibiotics for viral ARIs contributes to the dangerous rise in antibiotic-resistant bacteria, which cause more than two million infections and 23,000 deaths in the United States every year, according to the Centers for Disease Control and Prevention.

The report shows that antibiotic prescribing rates among various segments of the Medicaid population were notably different. For example, white women living outside of New York City received antibiotic prescriptions for 66.4 percent of ARI episodes, compared with prescribing for 49.7 percent of episodes in white men living in New York City. There were also wide variations between Medicaid managed care plans, with members in the plan with the highest prescription rate receiving antibiotics nearly twice as often as those in the plan with the lowest rates (75.4 percent versus 43.4 percent).

Overall, there were 1.27 million ARI episodes among 761,763 individuals over the five years studied, and antibiotics were prescribed in 58.2 percent of these episodes. Statewide, average annual and monthly prescription rates were stable over the study period, fluctuating between 56 percent and 60 percent.

“The findings of this analysis shine a spotlight on the distribution of potentially inappropriate antibiotic prescribing in New York's Medicaid Program,” said Chad Shearer, UHF vice president for policy and director of the Medicaid Institute. “Patient and provider education programs that target communities with high levels of prescribing may be most helpful in curbing antibiotic overuse.”

The report found that over half of the antibiotic prescriptions were filled following a diagnosis of acute pharyngitis or acute upper respiratory infection—conditions with vague symptoms such as coughing and sneezing. “These findings reveal a larger need for evidence-based physician and patient interventions such as communication training, clinical decision support, and public education posters in the examination room,” said Misha Sharp, research analyst with UHF and a co-author of the report.

The report was co-authored by John Billings, professor of health policy and public service at New York University Wagner School of Public Policy, and Kacie Dragan, assistant research scientist with NYU Wagner.

The full report can be downloaded at the UHF website.

About United Hospital Fund

United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at and follow us on Twitter.

June 22, 2018
Focus Area
Clinical-Community PartnershipsQuality and EfficiencyCoverage and Access
Medicaid Institute