IDEAS home Printed from https://ideas.repec.org/a/eee/pubeco/v225y2023ics0047272723001627.html
   My bibliography  Save this article

Dangerous prescribing and healthcare fragmentation: Evidence from opioids

Author

Listed:
  • Ericson, Keith Marzilli
  • Sacarny, Adam
  • Zhou, Annetta

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 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.

Suggested Citation

  • Ericson, Keith Marzilli & Sacarny, Adam & Zhou, Annetta, 2023. "Dangerous prescribing and healthcare fragmentation: Evidence from opioids," Journal of Public Economics, Elsevier, vol. 225(C).
    • Handle: RePEc:eee:pubeco:v:225:y:2023:i:c:s0047272723001627
    DOI: 10.1016/j.jpubeco.2023.104980
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0047272723001627
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.jpubeco.2023.104980?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. 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.
    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. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    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.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Leila Agha & Keith Marzilli Ericson & Xiaoxi Zhao, 2020. "The Impact of Organizational Boundaries on Healthcare Coordination and Utilization," NBER Working Papers 28179, National Bureau of Economic Research, Inc.
    2. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2024. "Competition, quality and integrated health care," Journal of Health Economics, Elsevier, vol. 95(C).
    3. Orgul Ozturk & Yuan Hong & Suzanne McDermott & Margaret Turk, 2021. "Prescription Drug Monitoring Programs and Opioid Prescriptions for Disability Conditions," Applied Health Economics and Health Policy, Springer, vol. 19(3), pages 415-428, May.
    4. Gihleb, Rania & Giuntella, Osea & Zhang, Ning, 2020. "Prescription drug monitoring programs and neonatal outcomes," Regional Science and Urban Economics, Elsevier, vol. 81(C).
    5. Simone Balestra & Helge Liebert & Nicole Maestas & Tisamarie B. Sherry, 2021. "Behavioral Responses to Supply-Side Drug Policy During the Opioid Epidemic," NBER Working Papers 29596, National Bureau of Economic Research, Inc.
    6. Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    7. Gal Wettstein, 2019. "Health insurance and opioid deaths: Evidence from the Affordable Care Act young adult provision," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 666-677, May.
    8. Liebman, Eli & Lawler, Emily C. & Dunn, Abe & Ridley, David B., 2023. "Consequences of a shortage and rationing: Evidence from a pediatric vaccine," Journal of Health Economics, Elsevier, vol. 92(C).
    9. Shishir Shakya & Collin Hodges, 2023. "Must‐access prescription drug monitoring programs and retail opioid sales," Contemporary Economic Policy, Western Economic Association International, vol. 41(1), pages 146-165, January.
    10. Thomas C. Buchmueller & Colleen M. Carey & Giacomo Meille, 2020. "How well do doctors know their patients? Evidence from a mandatory access prescription drug monitoring program," Health Economics, John Wiley & Sons, Ltd., vol. 29(9), pages 957-974, September.
    11. Lindsey Rose Bullinger & Benjamin C. Ward, 2021. "What about the children? How opioid use affects child well‐being," Contemporary Economic Policy, Western Economic Association International, vol. 39(4), pages 737-759, October.
    12. Deiana Claudio & Giua Ludovica, 2021. "The Intended and Unintended Effects of Opioid Policies on Prescription Opioids and Crime," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 21(2), pages 751-792, April.
    13. Lucy Xiaolu Wang, 2021. "The complementarity of drug monitoring programs and health IT for reducing opioid‐related mortality and morbidity," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2026-2046, September.
    14. Kaestner, Robert & Ziedan, Engy, 2023. "Effects of prescription opioids on employment, earnings, marriage, disability and mortality: Evidence from state opioid control policies," Labour Economics, Elsevier, vol. 82(C).
    15. David Cho & Alvaro Mezza & Joshua Montes, 2022. "Choices and Implications when Measuring the Local Supply of Prescription Opioids," Finance and Economics Discussion Series 2022-078, Board of Governors of the Federal Reserve System (U.S.).
    16. Kim, Bokyung, 2021. "Must-access prescription drug monitoring programs and the opioid overdose epidemic: The unintended consequences," Journal of Health Economics, Elsevier, vol. 75(C).
    17. Leila Agha & Keith Marzilli Ericson & Kimberley H. Geissler & James B. Rebitzer, 2022. "Team Relationships and Performance: Evidence from Healthcare Referral Networks," Management Science, INFORMS, vol. 68(5), pages 3735-3754, May.
    18. Dhaval Dave & Monica Deza & Brady Horn, 2021. "Prescription drug monitoring programs, opioid abuse, and crime," Southern Economic Journal, John Wiley & Sons, vol. 87(3), pages 808-848, January.
    19. David Cho & Daniel I. García & Joshua Montes & Alison E. Weingarden, 2021. "Labor Market Effects of the Oxycodone-Heroin Epidemic," Finance and Economics Discussion Series 2021-025, Board of Governors of the Federal Reserve System (U.S.).
    20. Dow, Wiiliam H & Godoey, Anna & Lowenstein, Christopher A & Reich, Michael, 2019. "Can Economic Policies Reduce Deaths of Despair? Working Paper #104-19," Institute for Research on Labor and Employment, Working Paper Series qt14f015df, Institute of Industrial Relations, UC Berkeley.

    More about this item

    Keywords

    Healthcare productivity; Coordination failures; Healthcare fragmentation; Opioid prescribing; Regional variation;
    All these keywords.

    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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:pubeco:v:225:y:2023:i:c:s0047272723001627. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505578 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.