Américo Pedro, Rocha Rudi
Department of Economics, PUC-Rio, Brazil.
São Paulo School of Business Administration, Getulio Vargas Foundation, Brazil.
J Health Econ. 2020 Jul;72:102347. doi: 10.1016/j.jhealeco.2020.102347. Epub 2020 Jun 8.
This paper evaluates the health effects of a large-scale subsidizing program of prescription drugs introduced in Brazil, the Aqui Tem Farmácia Popular program (ATFP). We exploit features of the program to identify its effects on mortality and hospitalization rates by diabetes for individuals aged 40 years or more. We find weak evidence for a decline in mortality, but a robust reduction in hospitalization rates. According to our preferred specification, an additional ATFP pharmacy per 100,000 inhabitants is associated with a decrease in hospitalization rates by diabetes of 8.2, which corresponds to 3.6% of its baseline rate. Effects are larger for Type II diabetes in comparison to Type I, and among patients with relatively lower socioeconomic status. Overall, the results are consistent with insulin-dependent patients being relatively less responsive to subsidies because of higher immediate life-threatening risks; and with lower-SES individuals being more responsive because of liquidity constraints. These results support the view that the optimal design of health systems and cost-sharing mechanisms should take into account equity concerns, heterogeneous impacts by health condition, and their potential offsetting effects on the utilization of downstream health services.
本文评估了巴西推出的一项大规模处方药补贴计划——“这里有大众药房”计划（ATFP）对健康的影响。我们利用该计划的特点，确定其对40岁及以上人群糖尿病死亡率和住院率的影响。我们发现死亡率下降的证据不足，但住院率有显著降低。根据我们的首选规格，每10万居民增加一家ATFP药房与糖尿病住院率降低8.2相关，这相当于其基线率的3.6%。与I型糖尿病相比，II型糖尿病的影响更大，在社会经济地位相对较低的患者中也是如此。总体而言，结果表明，由于更高的直接危及生命的风险，胰岛素依赖型患者对补贴的反应相对较小；而由于流动性限制，社会经济地位较低的个体反应更大。这些结果支持这样一种观点，即卫生系统和成本分担机制的最优设计应考虑公平问题、健康状况的异质性影响及其对下游卫生服务利用的潜在抵消作用。
