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The Contribution of Patients and Providers to the Overuse of Prescription Drugs

Author

Listed:
  • Carolina Lopez
  • Anja Sautmann
  • Simone Schaner

Abstract

Overuse of medical care is often attributed to an informed expert problem, whereby doctors induce patients to purchase unnecessary treatments. Alternatively, patients may drive overuse of medications by exerting pressure on doctors to overprescribe, undermining the doctor's gatekeeping function for prescription medications. We develop a theoretical framework and designed a randomized trial to identify the importance of patients in driving overuse of antimalarials in community health clinics in Mali. Holding doctors' financial incentives constant, we vary patients' information about the availability of a discount for standard malaria treatment. We find evidence of patient-driven demand: directly informing patients about the price reduction, instead of allowing doctors to choose whether to share this information, increases use of the discount by 35 percent and overall rates of antimalarial use by 11 percent. This increase is driven by patients least likely to have malaria, leading to a worse match between treatment and cause of illness. We find no evidence that doctors use their information advantage to sell more powerful malaria treatment or increase revenue.

Suggested Citation

  • Carolina Lopez & Anja Sautmann & Simone Schaner, 2018. "The Contribution of Patients and Providers to the Overuse of Prescription Drugs," NBER Working Papers 25284, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:25284
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    References listed on IDEAS

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    1. Anja Sautmann & Samuel Brown & Mark Dean, 2016. "Subsidies, Information, and the Timing of Childrenís Health Care in Mali," Working Papers 2016-2, Brown University, Department of Economics.
    2. Michael Kremer & Jessica Leino & Edward Miguel & Alix Peterson Zwane, 2011. "Spring Cleaning: Rural Water Impacts, Valuation, and Property Rights Institutions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(1), pages 145-205.
    3. Nava Ashraf & James Berry & Jesse M. Shapiro, 2010. "Can Higher Prices Stimulate Product Use? Evidence from a Field Experiment in Zambia," American Economic Review, American Economic Association, vol. 100(5), pages 2383-2413, December.
    4. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    5. Alessandro Tarozzi & Aprajit Mahajan & Brian Blackburn & Dan Kopf & Lakshmi Krishnan & Joanne Yoong, 2014. "Micro-loans, Insecticide-Treated Bednets, and Malaria: Evidence from a Randomized Controlled Trial in Orissa, India," American Economic Review, American Economic Association, vol. 104(7), pages 1909-1941, July.
    6. Pascaline Dupas, 2014. "Short‐Run Subsidies and Long‐Run Adoption of New Health Products: Evidence From a Field Experiment," Econometrica, Econometric Society, vol. 82(1), pages 197-228, January.
    7. Jishnu Das & Alaka Holla & Aakash Mohpal & Karthik Muralidharan, 2016. "Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India," American Economic Review, American Economic Association, vol. 106(12), pages 3765-3799, December.
    8. Jessica Cohen & Pascaline Dupas & Simone Schaner, 2015. "Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial," American Economic Review, American Economic Association, vol. 105(2), pages 609-645, February.
    9. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2014. "Addressing antibiotic abuse in China: An experimental audit study," Journal of Development Economics, Elsevier, vol. 110(C), pages 39-51.
    10. Anja Sautmann & Samuel Brown & Mark Dean, 2016. "Subsidies, Information, and the Timing of Childrenís Health Care in Mali," Working Papers 2016-2, Brown University, Department of Economics.
    11. Jessica Cohen & Pascaline Dupas, 2010. "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 1-45.
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    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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