Hospitals are currently penalised for using last-resort antibiotics (high cost, low margin) and rewarded for throughput over outcomes. StewardshipFirst flips this incentive structure through a national value-based reimbursement framework for antibiotic stewardship.

Hospitals receive a Stewardship Performance Score (SPS) calculated quarterly from: (a) appropriate antibiotic prescribing rates vs. aureus). 5% reimbursement premium on all DRG payments — worth $3–8M/year for a mid-size hospital. Bottom-quartile hospitals face mandatory stewardship programme accreditation.

A $500M national Stewardship Investment Fund subsidises the upfront cost of hiring antibiotic stewardship pharmacists ($120K/yr) and clinical decision support software in hospitals that cannot self-fund. This creates a self-sustaining market: hospitals invest in stewardship because it improves their SPS score, which improves reimbursement, which funds more stewardship.