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Dangerous Prescribing and Healthcare Fragmentation: Evidence from Opioids

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  • Keith Marzilli Ericson
  • Adam Sacarny
  • R. Annetta Zhou

Abstract

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 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.

Suggested Citation

  • Keith Marzilli Ericson & Adam Sacarny & R. Annetta Zhou, 2022. "Dangerous Prescribing and Healthcare Fragmentation: Evidence from Opioids," NBER Working Papers 29992, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:29992
    Note: AG EH
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    References listed on IDEAS

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    1. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    2. Leila Agha & Keith Marzilli Ericson & Xiaoxi Zhao, 2023. "The Impact of Organizational Boundaries on Health Care Coordination and Utilization," American Economic Journal: Economic Policy, American Economic Association, vol. 15(3), pages 184-214, August.
    3. Randall D. Cebul & James B. Rebitzer & Lowell J. Taylor & Mark E. Votruba, 2008. "Organizational Fragmentation and Care Quality in the U.S. Healthcare System," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 93-113, Fall.
    4. Agha, Leila & Frandsen, Brigham & Rebitzer, James B., 2019. "Fragmented division of labor and healthcare costs: Evidence from moves across regions," Journal of Public Economics, Elsevier, vol. 169(C), pages 144-159.
    5. Thomas C. Buchmueller & Colleen Carey, 2018. "The Effect of Prescription Drug Monitoring Programs on Opioid Utilization in Medicare," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 77-112, February.
    6. Jill Horwitz & Corey S. Davis & Lynn S. McClelland & Rebecca S. Fordon & Ellen Meara, 2018. "The Problem of Data Quality in Analyses of Opioid Regulation: The Case of Prescription Drug Monitoring Programs," NBER Working Papers 24947, National Bureau of Economic Research, Inc.
    7. Laurence C. Baker & M. Kate Bundorf & Daniel P. Kessler, 2020. "Does Multispecialty Practice Enhance Physician Market Power?," American Journal of Health Economics, University of Chicago Press, vol. 6(3), pages 324-347.
    8. Anca M. Grecu & Dhaval M. Dave & Henry Saffer, 2019. "Mandatory Access Prescription Drug Monitoring Programs and Prescription Drug Abuse," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(1), pages 181-209, January.
    9. Capps, Cory & Dranove, David & Ody, Christopher, 2018. "The effect of hospital acquisitions of physician practices on prices and spending," Journal of Health Economics, Elsevier, vol. 59(C), pages 139-152.
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    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • L14 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Transactional Relationships; Contracts and Reputation
    • L22 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Firm Organization and Market Structure

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