Misalignment of Stakeholder Incentives in the Opioid Crisis

Alireza Boloori, Bengt B. Arnetz, Frederi Viens, Taps Maiti and Judith E. Arnetz
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Alireza Boloori: Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
Bengt B. Arnetz: Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA
Frederi Viens: Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
Taps Maiti: Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA
Judith E. Arnetz: Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA

IJERPH, 2020, vol. 17, issue 20, 1-19

Abstract: The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

Keywords: opioid crisis; opioid/substance use disorder; pain management; misalignment of incentives; stakeholders; cost; quality; access (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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