16 research outputs found
Simulating WTP Values from Random-Coefficient Models
No full textDiscrete Choice Experiments (DCEs) designed to estimate willingness-to-pay (WTP) values are very popular in health economics. With increased computation power and advanced simulation techniques, random-coefficient models have gained an increasing importance in applied work as they allow for taste heterogeneity. This paper discusses the parametrical derivation of WTP values from estimated random-coefficient models and shows how these values can be simulated in cases where they do not have a known distribution.willingness-to-pay, discrete choice, simulation, random-coe±cient models
Physician dispensing and the choice between generic and brand-name drugs – Do margins affect choice?
No full textMany politicians blame physician dispensing (PD) to increase health care expenditure and to undermine independence of drug prescription and income leading to a suboptimal medication. Therefore, PD is not allowed in most OECD countries. In Switzerland, PD is allowed in some regions depending on the density of pharmacies. This enables to investigate the difference in prescribing behavior between physician which gain income from prescribing a specific drug and their colleagues which prescribe the drug but do not sell it. Because the considered drugs are bioequivalent we focus on the economic consequence of PD. We analyze the prescribing behavior of Swiss physicians using cross-sectional data between 2005 and 2007 for three important agents. The results support our hypothesis that dispensing physicians have a higher probability of prescribing the drug with the (most likely) higher margin compared to non-dispensing physicians. Further, generic drugs are prescribed more often to patients with higher cost-sharing while patients' cost-sharing is less influential with PD. High-income patients face a much higher probability to receive the brand-name drug due to their lower marginal utility of income. Today's administered reimbursement prices for generics seem to be high enough to gain physicians for prescribing generics because of their high margins.Physician dispensing, prescribing behavior, generics, brand-name drugs
The relation between competition and innovation – Why is it such a mess?
No full textUsing a general two-stage framework, this paper gives sufficient conditions for increasing competition to have negative or positive effects on R&D-investment, respectively. Both possibilities arise in plausible situations, even if one uses relatively narrow definitions of increasing competition. The paper also shows that competition is more likely to increase the investments of leaders than those of laggards. When R&D-spillovers are strong, competition is less likely to increase investments. The paper also identifies conditions under which low initial levels of competition make a positive effects of competition on investment more likely. Extending the basic framework, the paper shows that separation of ownership and control, endogenous entry and cumulative investments make positive effects of competition on investment more likely. Imperfect upstream competition weakens the effects of competition on investment.competition, investment, cost reduction
Lobbying and the Power of Multinational Firms
No full textAre national or multinational firms better lobbyists? This paper analyzes the extent of national environmental regulation when policy is determined in a lobbying game between a government and firm. We compare the resulting regulation levels for national and multinational firms. We identify three countervailing forces, the easier-to-shut-down effect, the easier-to-curb-exports effect and the multiple-plant effect. The interplay of these three forces determines whether national or multinational firms produce more, depending on such parameters as the potential environmental damages, transportation costs and the in uence of the firm. We also show that welfare levels are higher with multinational firms than with national firms when there is no lobbying, but that lobbying can reverse the welfare ordering.Multinational enterprises, regulation, policy formation, lobbying, interest groups, foreign direct investment
Lead me not into temptation: drug price regulation and dispensing physicians in Switzerland
No full textWhile most countries separate drug prescription and dispensation to ensure independent drug choice, some allow this combination to increase pharmaceutical access in rural areas or to increase the utilization of pharmacist skills. A drawback of this approach is that dispensing physicians or prescribing pharmacists may be incentivized to increase their own profits through the prescription of cost-inefficient drug packages, leading to an increase in pharmaceutical spending. Switzerland constitutes an interesting example of where dispensing and non-dispensing physicians coexist, permitting a comparison of their prescribing behavior. The present study shows that drug margin optimization is possible under the current drug price regulation scheme in Switzerland. Using drug claims data, empirical findings indicate a 5-10% higher margin per dose for dispensing physicians compared to pharmacists. Cost per dose is 3-5% higher when dispensed by physicians instead of pharmacists
Provider and consumer preferences in health care markets
No full textThis dissertation investigates provider and consumer preferences in health care markets as they pertain to policy decisions and shows that, if placing priority on a nation’s welfare, policy makers would do well to design reforms that not only address, but also, are largely informed by, provider and consumer feedback. For example, if citizens’ preferences point to a willingness to pay high insurance premiums (or taxes) for health care consumption, reforms to cut cost through rationing health care provision may actually decrease a nation’s welfare. Each chapter of this dissertation can be considered as self-contained. Following a brief discussion of the relevance of preference measurement, this dissertation first analyzes what it is that physicians dislike about Managed Care (MC). Supported by evidence drawn from a discrete choice experiment conducted with Swiss ambulatory care physicians, findings demonstrate that private health insurers must be able to achieve substantial savings in order to create sufficient incentives for physicians to participate voluntarily in MC. The same is true for accepting budgetary co-responsibility investigated in Chapter 3. The results show that, as long as the alternative of conventional private practice exists, physicians are less likely to join physician networks and accept budgetary responsibility unless they are highly compensated for the additional financial risk. Chapter 4 compares consumer preferences for health insurance in Germany and the Netherlands. Using two discrete choice experiments, this chapter compares consumer willingness to pay for health insurance attributes. While the two populations agree in their resistance against MC-type attributes, German respondents required much higher compensation in order to give up free physician choice and instead accept a physician list. Chapters 5 and 6 examine physicians’ preferences for drug versions and package sizes. Chapter 5 tests physicians’ imperfect agency and reveals a significant positive association between physician dispensing and the use of generic drugs. Chapter 6 explores whether or not dispensing physicians optimize their own drug margins by prescribing margin-optimizing package sizes. Findings suggest that dispensing physicians achieve higher drug margins than pharmacies, which results in higher drug costs and inefficient package choices for patients
Simulating WTP Values from Random-Coefficient Models
No full textDiscrete Choice Experiments (DCEs) designed to estimate willingness-to-pay (WTP) values are very popular in health economics. With increased computation power and advanced simulation techniques, random-coefficient models have gained an increasing importance in applied work as they allow for taste heterogeneity. This paper discusses the parametrical derivation of WTP values from estimated random-coefficient models and shows how these values can be simulated in cases where they do not have a known distribution
Lead me not into temptation: drug price regulation and dispensing physicians in Switzerland
No full textWhile most countries separate drug prescription and dispensation to ensure independent drug choice, some allow this combination to increase pharmaceutical access in rural areas or to increase the utilization of pharmacist skills. A drawback of this approach is that dispensing physicians or prescribing pharmacists may be incentivized to increase their own profits through the prescription of cost-inefficient drug packages, leading to an increase in pharmaceutical spending. Switzerland constitutes an interesting example of where dispensing and non-dispensing physicians coexist, permitting a comparison of their prescribing behavior. The present study shows that drug margin optimization is possible under the current drug price regulation scheme in Switzerland. Using drug claims data, empirical findings indicate a 5-10% higher margin per dose for dispensing physicians compared to pharmacists. Cost per dose is 3-5% higher when dispensed by physicians instead of pharmacists
What do physicians dislike about managed care? Evidence from a choice experiment
No full textManaged care (MC) imposes restrictions on physician behavior, but also holds promises, especially in terms of cost savings and improvements in treatment quality. This contribution reports on private-practice physicians' willingness to accept (WTA, compensation asked, respectively) for several MC features. In 2011, 1,088 Swiss ambulatory care physicians participated in a discrete choice experiment, which permits putting WTA values on MC attributes. With the exception of shared decision making and up to six quality circle meetings per year, all attributes are associated with non-zero WTA values. Thus, health insurers must be able to achieve substantial savings in order to create sufficient incentives for Swiss physicians to participate voluntarily in MC plan
What do physicians dislike about managed care? Evidence from a choice experiment
No full textManaged care (MC) imposes restrictions on physician behavior, but also holds promises, especially in terms of cost savings and improvements in treatment quality. This contribution reports on private-practice physicians' willingness to accept (WTA, compensation asked, respectively) for several MC features. In 2011, 1,088 Swiss ambulatory care physicians participated in a discrete choice experiment, which permits putting WTA values on MC attributes. With the exception of shared decision making and up to six quality circle meetings per year, all attributes are associated with non-zero WTA values. Thus, health insurers must be able to achieve substantial savings in order to create sufficient incentives for Swiss physicians to participate voluntarily in MC plan
