Econ Papers Daily / 期刊论文
医疗保险扩展对无保险人群药品价格与需求的影响
The effect of health insurance expansion on price and demand for medications among the uninsured
摘要
Social health insurance expansions can affect not only new beneficiaries but also those who remain outside the program. This paper studies these spillovers in the context of Medicare Part D. Increases in insured demand can raise or lower price depending on market conditions: they may increase price when pharmaceutical firms face less elastic demand, but reduce price when demand concentration strengthens bargaining and pass-through in competitive markets. I find that Part D lowered the out-of-pocket unit price paid by Americans under age 65 without prescription drug insurance. Price declines are larger in therapeutic classes more exposed to Part D and in classes with stronger within-class competition, consistent with a demand-concentration channel. Demand increases mainly for generic drugs and among existing users. The implied consumer-surplus gain is roughly $76 per person per year, comprising about $65 from lower price on inframarginal consumption and $11 from additional consumption. Demand responses appear strongest among lower-income, younger, and healthier uninsured individuals, consistent with greater pre-existing non-adherence. Although price fall across several drug classes, demand does not increase significantly for medications associated with greater overuse in the United States, suggesting potentially positive net health spillovers.
中文摘要
社会医疗保险的扩展不仅会影响新增受益者，还可能影响那些仍处于计划之外的人群。本文以联邦医疗保险D部分为背景，研究这些溢出效应。受保需求的增加可能根据市场条件提高或降低价格：当制药企业面临较低的需求弹性时，价格可能上升；但当需求集中度增强议价能力并在竞争性市场中促进传导时，价格则可能下降。我发现，D部分降低了65岁以下无处方药保险的美国人所支付的自付单位价格。价格下降在受D部分影响更大的治疗类别以及同类内部竞争更强的类别中更为显著，这与需求集中渠道一致。需求增长主要集中于仿制药和现有使用者群体。由此产生的消费者剩余收益约为每人每年76美元，其中约65美元来自边际内消费的价格下降，11美元来自额外消费。需求响应在低收入、较年轻和较健康的未参保个体中表现最为明显，这与既有较高的不依从性一致。尽管多种药物类别的价格均有所下降，但与美国过度使用相关的药物的需求并未显著增加，这表明可能存在正向的净健康溢出效应。