Prescribers Under Pressure? An Examination of Healthcare Policy, Prescribing Workload, and Competition on Opioid Prescribing

ABSTRACT Despite the daunting societal and financial impacts of the opioid crisis, extant research offers only a partial understanding of it, particularly regarding the role of healthcare policy. Accordingly, grounded in institutional theory, we examined how a policy that monitors and financially incentivizes patient satisfaction with pain management during a hospital stay affected opioid prescribing behavior of frontline workers (i.e., prescribers). Leveraging 43 months of opioid prescribing data, our research reveals that the introduction of such a policy is associated with higher opioid prescribing intensity. Furthermore, our results reveal that the policy's unintended consequences were intensified under high levels of prescribing workload and market competition. These findings augment the understanding of the negative impacts of the former and unveil an unfavorable corollary to the positive impacts of the latter. We complemented these results with a qualitative study that revealed the presence of coercive, mimetic, and normative pressures and the influence of prescribing workload and market competition in the prescribing context, instilling confidence in our theorizing, results, and contributions. Our study culminates in prescriptive implications for policymakers, prescribers, and healthcare leaders.