Moreno Gigi, van Eijndhoven Emma, Benner Jennifer, Sullivan Jeffrey
Precision Health Economics, Los Angeles, CA,USA.
Forum Health Econ Policy. 2017 Jan 20;20(2):/j/fhep.2017.20.issue-2/fhep-2016-0011/fhep-2016-0011.xml. doi: 10.1515/fhep-2016-0011.
Price controls for prescription drugs are once again at the forefront of policy discussions in the United States. Much of the focus has been on the potential short-term savings - in terms of lower spending - although evidence suggests price controls can dampen innovation and adversely affect long-term population health. This paper applies the Health Economics Medical Innovation Simulation, a microsimulation of older Americans, to estimate the long-term impacts of government price setting in Medicare Part D, using pricing in the Federal Veterans Health Administration program as a proxy. We find that VA-style pricing policies would save between $0.1 trillion and $0.3 trillion (US$2015) in lifetime drug spending for people born in 1949-2005. However, such savings come with social costs. After accounting for innovation spillovers, we find that price setting in Part D reduces the number of new drug introductions by as much as 25% relative to the status quo. As a result, life expectancy for the cohort born in 1991-1995 is reduced by almost 2 years relative to the status quo. Overall, we find that price controls would reduce lifetime welfare by $5.7 to $13.3 trillion (US$2015) for the US population born in 1949-2005.
处方药价格管制再次成为美国政策讨论的焦点。尽管有证据表明价格管制会抑制创新并对长期人口健康产生不利影响，但大部分讨论都集中在潜在的短期节省方面，即降低支出。本文运用健康经济学医疗创新模拟模型（一种针对美国老年人的微观模拟模型），以联邦退伍军人健康管理局项目中的定价为参照，来估算政府在医疗保险D部分设定价格的长期影响。我们发现，类似退伍军人管理局的定价政策将为1949年至2005年出生的人群节省0.1万亿至0.3万亿美元（2015年美元价值）的终身药品支出。然而，这种节省伴随着社会成本。在考虑创新溢出效应后，我们发现医疗保险D部分的价格设定相对于现状而言，会使新药推出数量减少多达25%。结果，1991年至1995年出生的人群的预期寿命相对于现状减少了近2年。总体而言，我们发现价格管制将使1949年至2005年出生的美国人群的终身福利减少5.7万亿至13.3万亿美元（2015年美元价值）。
