Does increased competition between healthcare providers influence the number of opioid prescriptions dispensed?

Sammanfattning: Mortality related to drug abuse, primarily from opioids is very high in Sweden. The increased access to opioids have had severe consequences such as abuse, illegal opioid trafficking and overdoses. One contributing factor to this development is suggested to be over-prescriptions by physicians. The aim of this paper is to examine the effect of increased competition between healthcare providers, caused by the healthcare choice system reform, on prescriptions of opioids. This competition inducing reform was adopted at different time points in different counties between 2007 and 2010. Considering the staggered adoption scheme, it is possible to use a difference-in-difference methodology to identify the effect of the reform on the number of opioid prescriptions dispensed. The main result shows that prescriptions overall declined as a consequence of the reform. Although, during the reform adoption year specifically, there is some indication of a positive effect of competition on prescriptions, but this effect do not persist. Thus, overall, the reform do not seem to have contributed to increases in opioid prescriptions. These results are however not robust across various model specifications, as the statistical significance disappears when modifications are made. Therefore, this thesis cannot conclude anything with certainty on whether the healthcare choice system actually had an effect on prescriptions at all.