Mendoza Roger Lee
Department of Management, College of Business and Economics, California State University-Los Angeles, Los Angeles, CA, USA.
J Med Econ. 2020 Sep;23(9):915-922. doi: 10.1080/13696998.2020.1772797. Epub 2020 Jun 25.
Prescription drug prices in the United States are considered rather extreme. Americans spend over $460 billion on drugs annually, or almost 17 percent of total national healthcare spending. How innovation incentives and insurance coverage drive pricing, diffusion, and utilization of drugs, under conditions of risk and competition, are multi-dimensional issues in medical economics that remain under-explored in the current empirical literature. We seek to address these issues in reviewing relevant studies presented at the 2020 AEA-ASSA annual convention.
Drawn from the 2020 convention panel sessions devoted to health economics, empirical evidence was thematically analyzed for charted new research terrains and trajectories. Their theoretical and practical implications on efficiency, effectiveness, and value in drug production and consumption were then identified.
With certain qualifications, evidence confirms price inelasticity of prescription drugs and medical treatments, along with substitution effects from high or continuously rising prices. While health insurance induces moral hazard, albeit on a larger scale than previously considered, losing dependent coverage can incentivize price-substitution to risky and illegal drugs, including those sold on the black market. At the firm level, drug patenting and exclusivity rights suggest that innovation incentives increase new or novel clinical trials and generic utilization to a considerable extent. But innovation can produce strong, offsetting effects. It can distort competition and cause (at times sharp) price increases from product-hopping, (compensatory) list pricing, industry mergers and acquisitions, and capture of positive spillovers by competitors, rather than by focal developers, in follow-on innovations. In fine, there remains room for opportunism among firms, particularly market incumbents, and many loopholes are unplugged by U.S. healthcare reform. These make drug utilization costly to the insured, and risky to those who are - or become - uninsured or underinsured for various reasons.
The fundamental disconnect between innovation cost and drug pricing demands public attention and policy intervention, which have proved largely elusive to date. Gaming the system in the name of scientific invention and discovery to reap additional benefits, at the expense of consumer health and income, brings to question the offsetting benefits of firm innovation. It also raises separate issues of fairness and equity. Innovation needs to be considered from the perspective of value lines and beyond conventional marketing incentives to drug utilization, with or without insurance coverage. Cost-effectiveness and cost-benefit analyses figure prominently under a value-based system of resource allocation, insurance, medical prescription, purchasing, and reimbursement.
美国处方药价格被认为相当极端。美国人每年在药品上花费超过4600亿美元，几乎占全国医疗保健总支出的17%。在风险和竞争条件下，创新激励措施和保险覆盖范围如何推动药品定价、传播和使用，是医学经济学中的多维度问题，在当前的实证文献中仍未得到充分探讨。我们试图在回顾2020年美国经济学会-美国社会科学协会年会上发表的相关研究时解决这些问题。
从2020年专门讨论卫生经济学的大会小组会议中提取内容，对实证证据进行主题分析，以绘制新的研究领域和轨迹。然后确定它们对药品生产和消费中的效率、有效性和价值的理论和实际影响。
在某些条件下，证据证实了处方药和医疗治疗的价格无弹性，以及高价或持续上涨价格带来的替代效应。虽然医疗保险会引发道德风险，尽管其规模比之前认为的更大，但失去受抚养人的保险覆盖可能会促使人们转向使用有风险的非法药物，包括在黑市上出售的药物。在企业层面，药品专利和专有权表明，创新激励措施在很大程度上增加了新的或新颖的临床试验以及仿制药的使用。但创新也可能产生强大的抵消效应。它可能会扭曲竞争，并导致因产品跳跃、（补偿性）标价、行业并购以及后续创新中竞争对手而非核心开发者获取积极溢出效应而出现（有时是急剧的）价格上涨。总之，企业中仍存在机会主义空间，尤其是市场主导企业，而且美国医疗改革并未填补许多漏洞。这些使得药品使用对参保者来说成本高昂，而对那些因各种原因未参保或保险不足的人来说则存在风险。
创新成本与药品定价之间的根本脱节需要公众关注和政策干预，而迄今为止，这在很大程度上难以实现。以科学发明和发现之名操纵系统以获取额外利益，却以消费者健康和收入为代价，这让人质疑企业创新的抵消效益。这也引发了公平性的单独问题。需要从价值线的角度以及超越传统药品使用营销激励措施（无论有无保险覆盖）来考虑创新。在基于价值的资源分配、保险、医疗处方、采购和报销体系下，成本效益分析和成本效益分析尤为重要。
