Journal of Public Economics · 2023 · Keith M. Marzilli Ericson、Adam Sacarny、Annetta Zhou
中文摘要
由多名不同医生提供的碎片化医疗服务会导致成本上升、质量下降，但它是否也会造成危险的阿片类药物处方？其影响在理论上并不明确，因为碎片化既可能引发代价高昂的协调失灵，也可能促进更高程度的专业化。本文考察危险的阿片类药物处方，将其定义为接受高剂量、长处方疗程或存在有害相互作用的药物。从横截面来看，医疗服务碎片化程度较高的地区，危险的阿片类药物处方水平较低。这一关系仅为相关关系，可能源于未观测到的患者层面混杂因素。通过考察跨地区迁移的患者来识别医疗服务碎片化的影响，我们发现地区碎片化对危险的阿片类药物处方具有较为精确的零效应。这些结果使人们对碎片化在这一现象中的作用产生质疑，并凸显了其他因素在驱动该现象方面可能发挥的作用。
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.