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RISS 인기검색어
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- 저자 : Virabhak, Suchin (검색결과 1 건)
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Essays on the economics of pharmaceuticals
Virabhak, Suchin Columbia University 2005 해외박사(DDOD)
소속기관이 구독 중이 아닌 경우 오후 4시부터 익일 오전 9시까지 원문보기가 가능합니다.
Chapter One examines Medicaid preferred drug lists (PDLs), a cost-containment tool that designates specific drugs for use by Medicaid beneficiaries. I develop an empirical model to measure the direct and spillover effects of Medicaid PDL across Medicaid, cash and third-party payer markets; and apply product level panel data to the cardiovascular markets in Illinois and Louisiana. I find a significant decrease in post-PDL Medicaid prescription shares of drugs excluded from the PDL. Spillovers onto the third party and cash market are also statistically significant. Moreover, a more restrictive prior authorization procedure has a greater impact on prescription shares. There is evidence of a gradual adjustment in prescription shares. Last, the impact of PDLs is stronger among physicians with a higher share of Medicaid prescriptions. Part I of Chapter Two focuses on generic competition following the enactment of the 1984 Waxman-Hatch Act. Unlike existing literature, I employ antibiotics as a control group to infer legislation-induced increases in generic competition. Using FDA drug approval data, I find evidence that the Act enhanced generic competition. Moreover, the overall impact of the Act is greater for newer drugs than older drugs. In Part II, I explore the factors affecting voluntary drug exit in a framework of a duration model. Using FDA drug approval and withdrawal data and the National Drug Code Directory, I find evidence that drug exit is exacerbated by generic competition, while the impact competition between other branded drugs within its therapeutic class, namely "between-patent competition", is not statistically significant. In Chapter Three, we test the pharmaceutical-embodied technical progress hypothesis-that newer drugs increase the length and quality of life-and estimate the rate of progress. We estimate health production functions using prescription-level, cross-sectional data derived primarily from the 1997 Medical Expenditure Panel Survey. We find that people who used newer drugs had better post-treatment health than people using older drugs for the same condition, controlling for pre-treatment health, age, sex, etc. The estimated cost of an increase in drug vintage required to keep a person alive is lower than some estimates of the value of remaining alive for one month.
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