# Cultures of Activity, Cultivating Resistance

## TL;DR

This paper shows how hospital funding models can unintentionally encourage antimicrobial resistance by rewarding increased medical activity.

## Contribution

The paper introduces a novel economic perspective on AMR, highlighting how funding structures influence institutional priorities.

## Key findings

- Activity-based funding models can treat rising resistance as beneficial due to increased reimbursement.
- Funding paradigms fail to value reduced activity, undermining AMR mitigation efforts.
- Interviews reveal ingrained assumptions about value in hospital organizational practices.

## Abstract

The problem of antimicrobial resistance (AMR) is often viewed through biomedical and/or behavioral lenses, with the underlying economic principles and “headwinds” shaping resistance less visible. In this paper, we focus on how healthcare funding models structure the ways AMR is perceived and addressed as an institutional priority. Specifically, we explore how activity-based funding reflects and operationalizes ingrained assumptions about what is valuable and/or worthwhile within the organizational ecology of the hospital. Drawing on interviews with 36 executives from several hospital clinical care settings across two Australian states, we illuminate the ways the activity-based funding paradigm works against efforts to combat AMR. Concerningly, we further observe how activity-based funding models can inadvertently position rising rates of resistance as a benefit—at least in the short term—as the new and intensified interventions required to address resistant infections require more “activity” and thus deliver higher reimbursement at the level of annualized budgets. In failing to recognize the (social and economic) value of reduced activity, activity-based funding risks contributing to AMR, rather than working to resolve it.