Working Paper: NBER ID: w25284
Authors: 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.
Keywords: antimalarials; overuse; prescription drugs; health policy; Mali
JEL Codes: I12; I18; O12
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Providing patients with information about a discount for malaria treatment (H43) | Increase in voucher redemption rates (H52) |
| Providing patients with information about a discount for malaria treatment (H43) | Increase in overall antimalarial use (O50) |
| Patients with fewer malaria symptoms (I10) | Increase in overall antimalarial use (O50) |
| Doctors not utilizing their informational advantage (I11) | No evidence of doctors withholding information to upsell treatments (I11) |
| Patients in the doctor voucher condition (I11) | Less likely to purchase severe treatments compared to those in the patient voucher condition (I18) |