The Contribution of Patients and Providers to the Overuse of Prescription Drugs

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