Indian Institution of Management, Ahmedabad, India.
University of Massachusetts, Amherst, USA.
Soc Sci Med. 2019 Sep;237:112480. doi: 10.1016/j.socscimed.2019.112480. Epub 2019 Aug 10.
Regulatory enforcement of product safety standards given health concerns, whether it is in romaine lettuce, smartphones or cars, is emerging to be a challenge for global public health. This is particularly true for developing economies with fragile institutions. In this context, recent studies on Indian pharmaceutical markets provide evidence suggesting that the sector is a hub for substandard quality of medicines. Departing from these prior studies which use randomly collected samples, we reinvestigate this question using novel pan-India market sales data of banned medicines from 0.75 million pharmacists and chemists in India. We find that indeed such medicines get sold in India even after bans are imposed on them in the period 2007 to 2013. However, there is a general decline in demand post ban for our focal molecules suggesting broad adherence to bans. We also observe regional heterogeneity in prevalence of banned medicines sold between rich and poor regions of India with the former counterintuitively showing more sales. That said, while Ozawa et al. (2018) argue that prevalence of substandard medicines is around 13% in low and middle-income countries, we find an infringement ratio which is more muted in India at about 5%. Finally, a regression-based examination suggests that prior firm presence in therapeutic markets and popularity of molecules positively impact the likelihood of sale of banned medicines in India. Our results are robust to alternative explanations and are substantiated with a theoretical set up examining firm trade-offs in the decision to infringe. India has recently been under the lens of the global access to medicines debate and our findings have important policy implications for global health.
由于健康问题，从罗马生菜、智能手机到汽车等产品的安全标准的监管执行，对全球公共卫生而言，正成为一项挑战。对于机构较为脆弱的发展中经济体而言，这一问题尤其突出。在此背景下，最近针对印度制药市场的研究提供了证据，表明该行业是药品质量不达标的中心。与这些先前使用随机收集样本的研究不同，我们利用印度全国范围内 75 万家药剂师和化学家的新型市场销售数据，重新调查了这一问题。我们发现，即使在 2007 年至 2013 年期间对这些药品实施了禁令，此类药品在印度仍有销售。然而，在我们关注的分子被禁售之后，需求普遍下降，这表明对禁令的广泛遵守。我们还观察到，在印度贫富地区之间，被禁售药品的销售存在地区差异，前者的销售量出人意料地更高。也就是说，尽管 Ozawa 等人（2018）认为，在中低收入国家，劣药的流行率约为 13%，但我们发现，在印度，侵权率更为温和，约为 5%。最后，基于回归的检验表明，在治疗市场中的先前公司存在和分子的知名度会积极影响在印度销售被禁售药品的可能性。我们的结果具有稳健性，可以通过检查公司在侵权决策中权衡取舍的理论框架加以证实。印度最近成为全球获得药品辩论的焦点，我们的研究结果对全球卫生政策具有重要意义。
