Leibowitz A, Manning W G, Newhouse J P
Soc Sci Med. 1985;21(10):1063-9. doi: 10.1016/0277-9536(85)90161-3.
This paper estimates how cost-sharing affects the use of prescription drugs. The data for this analysis are derived from the Rand Health Insurance Experiment (HIE), a randomized controlled trial that randomly assigned participants to insurance plans with varying coinsurance rates and deductibles. Therefore, the cost-sharing they faced was independent of their health and demographic characteristics. The paper used HIE data from four sites to estimate how drug expenditures vary by insurance plan, and to compare the plan response for drugs with that for all ambulatory expenses. The findings show that: (1) individuals with more generous insurance buy more prescription drugs; (2) the cost-sharing response for drugs is similar to the response for all ambulatory medical services; (3) the Dayton, Ohio site had significantly greater drug expenditures per capita than the other sites studied and a significantly higher proportion of drugs sold by physicians; and (4) the proportion of brand-name drugs among all drugs purchased in pharmacies was not a function of insurance plan. In the Dayton, Ohio site, a significantly higher proportion of the drugs purchased in pharmacies were brand-name rather than generic.
本文估计了费用分担如何影响处方药的使用。该分析的数据源自兰德健康保险实验（HIE），这是一项随机对照试验，将参与者随机分配到具有不同共保率和免赔额的保险计划中。因此，他们面临的费用分担与他们的健康和人口特征无关。本文使用来自四个地点的HIE数据来估计药品支出如何因保险计划而异，并比较药品的计划反应与所有门诊费用的反应。研究结果表明：（1）拥有更慷慨保险的个人购买更多处方药；（2）药品的费用分担反应与所有门诊医疗服务的反应相似；（3）俄亥俄州代顿市的人均药品支出明显高于其他研究地点，且医生销售的药品比例明显更高；（4）药店购买的所有药品中品牌药的比例与保险计划无关。在俄亥俄州代顿市，药店购买的药品中品牌药的比例明显高于非专利药。
