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Misalignment of Stakeholder Incentives in the Opioid Crisis

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 e...

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Autores principales: Boloori, Alireza, Arnetz, Bengt B., Viens, Frederi, Maiti, Taps, Arnetz, Judith E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589670/
https://www.ncbi.nlm.nih.gov/pubmed/33081276
http://dx.doi.org/10.3390/ijerph17207535
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author Boloori, Alireza
Arnetz, Bengt B.
Viens, Frederi
Maiti, Taps
Arnetz, Judith E.
author_facet Boloori, Alireza
Arnetz, Bengt B.
Viens, Frederi
Maiti, Taps
Arnetz, Judith E.
author_sort Boloori, Alireza
collection PubMed
description 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.
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spelling pubmed-75896702020-10-29 Misalignment of Stakeholder Incentives in the Opioid Crisis Boloori, Alireza Arnetz, Bengt B. Viens, Frederi Maiti, Taps Arnetz, Judith E. Int J Environ Res Public Health Review 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. MDPI 2020-10-16 2020-10 /pmc/articles/PMC7589670/ /pubmed/33081276 http://dx.doi.org/10.3390/ijerph17207535 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Boloori, Alireza
Arnetz, Bengt B.
Viens, Frederi
Maiti, Taps
Arnetz, Judith E.
Misalignment of Stakeholder Incentives in the Opioid Crisis
title Misalignment of Stakeholder Incentives in the Opioid Crisis
title_full Misalignment of Stakeholder Incentives in the Opioid Crisis
title_fullStr Misalignment of Stakeholder Incentives in the Opioid Crisis
title_full_unstemmed Misalignment of Stakeholder Incentives in the Opioid Crisis
title_short Misalignment of Stakeholder Incentives in the Opioid Crisis
title_sort misalignment of stakeholder incentives in the opioid crisis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589670/
https://www.ncbi.nlm.nih.gov/pubmed/33081276
http://dx.doi.org/10.3390/ijerph17207535
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