Dangerous prescribing and healthcare fragmentation: Evidence from opioids

• 成果类型: Article
• 署名作者: Ericson, Keith Marzilli; Sacarny, Adam; Zhou, Annetta
• 署名单位: Boston University; National Bureau of Economic Research; Columbia University; RAND Corporation
• 刊物名称: JOURNAL OF PUBLIC ECONOMICS
• ISSN/ISSBN: 0047-2727
• DOI: 10.1016/j.jpubeco.2023.104980
• 发表日期: 2023
• 关键词: Healthcare productivity; Coordination failures; Healthcare fragmentation; Opioid prescribing; Regional variation

摘要

Fragmented healthcare received from many different physicians results in higher costs and lower quality, but does it contribute to dangerous opioid prescribing? The effect is theoretically ambiguous because fragmentation can trigger costly coordination failures but also permits greater specialization. We examine dangerous opioid prescribing, defined as receiving high dosages, long prescription durations, or harmfully interacting medications. Cross-sectionally, regions with higher fragmentation have lower levels of dangerous opioid prescribing. This relationship is associational and may result from unobserved patient-level confounders. Identifying the impact of healthcare fragmentation by examining patients who move across regions, we find a relatively precise null effect of regional fragmentation on dangerous opioid prescribing. These results cast doubt on the role of fragmentation in this phenomenon and highlight the potential role of other forces in driving it.