Working Paper: NBER ID: w30889
Authors: Janet Currie; Anran Li; Molly Schnell
Abstract: We ask how competition influences the prescribing practices of physicians. Law changes granting nurse practitioners (NPs) the ability to prescribe controlled substances without physician collaboration or oversight generate exogenous variation in competition. In response, we find that general practice physicians (GPs) significantly increase their prescribing of controlled substances such as opioids and controlled anti-anxiety medications. GPs also increase their co-prescribing of opioids and benzodiazepines, a practice that goes against prescribing guidelines. These effects are more pronounced in areas with more NPs per GP at baseline, are concentrated in physician specialties that compete most directly with NPs, and are not observed for many non-controlled drug classes. Our findings are consistent with a simple model of physician behavior in which competition for patients leads physicians to move toward the preferences of marginal patients. These results demonstrate that more competition will not always lead to improvements in patient care and can instead lead to excessive service provision.
Keywords: competition; physician prescribing; nurse practitioners; controlled substances; healthcare policy
JEL Codes: I11; J44; L10
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| increased competition from nurse practitioners (NPs) (I11) | significant changes in the prescribing practices of general practitioners (GPs) (I11) |
| increased competition from nurse practitioners (NPs) (I11) | increase in prescribing of controlled substances by general practitioners (GPs) (I11) |
| increase in prescribing of controlled substances by general practitioners (GPs) (I11) | increase in prescribing of opioids and controlled antianxiety medications (I11) |
| increased competition from nurse practitioners (NPs) (I11) | GPs more likely to prescribe controlled substances in areas with higher baseline of NPs per GP (I11) |
| increased competition from nurse practitioners (NPs) (I11) | excessive service provision by general practitioners (GPs) (H51) |