Department of Economics, National Cheng-Kung University, Tainan, Taiwan.
Health Econ. 2012 May;21(5):496-513. doi: 10.1002/hec.1724. Epub 2011 Mar 10.
This paper contributes to the growing body of literature that debates whether the adoption of pharmaceutical innovation increases the overall expenditure on health care. By examining data obtained from Taiwan and focusing on diabetic patients, we use a new class of drugs, namely, thiazolidinediones, as an example to investigate the effect on health expenditure of prescribing new drugs to patients by focusing on the impact of treatment substitution and treatment expansion. Overall, our results indicate that the introduction of new drugs mainly impacts the outpatient drug expenditure and does not give rise to any offsetting effect on other outpatient and inpatient health expenditures. This suggests that the adoption of pharmaceutical innovation in treating diabetic patients is expenditure-increasing. In addition, we find evidence that the treatment substitution channel has a more significant impact on the level of health expenditure than the treatment expansion channel. An important policy implication for our finding is that the justification for increasing health expenditure on the treatment of diabetes is not conditional upon a lowering in the demand for other types of health-care services. By contrast, it is conditional upon the increased health benefits per se.
本文为探讨医药创新的采用是否会增加总体医疗保健支出这一争议提供了新的证据。我们利用来自台湾的数据，以糖尿病患者为研究对象，以噻唑烷二酮类药物这一新类药物为例，通过关注新药对患者处方的治疗替代和治疗扩张的影响，考察了对医疗支出的影响。总体而言，我们的研究结果表明，新药的引入主要影响门诊药品支出，不会对其他门诊和住院医疗支出产生任何抵消效应。这表明，采用医药创新来治疗糖尿病患者会增加医疗支出。此外，我们发现治疗替代渠道对医疗支出水平的影响比治疗扩张渠道更为显著。我们的研究结果表明，增加糖尿病治疗方面的医疗支出的理由并非取决于对其他类型医疗服务需求的降低，而是取决于医疗收益的增加本身。
