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The Human Cost of Collusion: Health Effects of a Mexican Insulin Cartel

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  • Aaron Barkley

Abstract

Despite recent attention to the role of competition in determining health outcomes in developed nations, little is known about how market power impedes access to quality care in lower-income countries. This paper studies the effects of policy changes that stopped collusion among firms supplying insulin to one of Mexico’s largest health care providers. I document increased insulin utilization and decreased diabetes complications and mortality following the sudden drop in insulin prices caused by the cartel’s collapse. These adverse health outcomes expand the assessment of damages caused by the cartel. The findings highlight the importance of market design policies in health markets, particularly for low- and middle-income countries.

Suggested Citation

  • Aaron Barkley, 2023. "The Human Cost of Collusion: Health Effects of a Mexican Insulin Cartel," Journal of the European Economic Association, European Economic Association, vol. 21(5), pages 1865-1904.
    • Handle: RePEc:oup:jeurec:v:21:y:2023:i:5:p:1865-1904.
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    1. Daniel Bennett & Wesley Yin, 2019. "The Market for High-Quality Medicine: Retail Chain Entry and Drug Quality in India," The Review of Economics and Statistics, MIT Press, vol. 101(1), pages 76-90, March.
    2. Kline Patrick & Santos Andres, 2012. "A Score Based Approach to Wild Bootstrap Inference," Journal of Econometric Methods, De Gruyter, vol. 1(1), pages 23-41, August.
    3. Ernesto Estrada & Samuel Vazquez, 2013. "Bid Rigging In Public Procurement Of Generic Drugs In Mexico," CPI Journal, Competition Policy International, vol. 9.
    4. Scott Duke Kominers & Alexander Teytelboym & Vincent P Crawford, 2017. "An invitation to market design," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 33(4), pages 541-571.
    5. Paul J Eliason & Benjamin Heebsh & Ryan C McDevitt & James W Roberts, 2020. "How Acquisitions Affect Firm Behavior and Performance: Evidence from the Dialysis Industry," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 135(1), pages 221-267.
    6. Liran Einav & Amy Finkelstein & Maria Polyakova, 2018. "Private Provision of Social Insurance: Drug-Specific Price Elasticities and Cost Sharing in Medicare Part D," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 122-153, August.
    7. Américo, Pedro & Rocha, Rudi, 2020. "Subsidizing access to prescription drugs and health outcomes: The case of diabetes," Journal of Health Economics, Elsevier, vol. 72(C).
    8. Robert Kaestner & Cuping Schiman & G. Caleb Alexander, 2019. "Effects of Prescription Drug Insurance on Hospitalization and Mortality: Evidence from Medicare Part D," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 86(3), pages 595-628, September.
    9. Timothy G. Conley & Christopher R. Taber, 2011. "Inference with "Difference in Differences" with a Small Number of Policy Changes," The Review of Economics and Statistics, MIT Press, vol. 93(1), pages 113-125, February.
    10. Marhsall, Robert C. & Marx, Leslie M., 2014. "The Economics of Collusion: Cartels and Bidding Rings," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262525941, December.
    11. Ho, Vivian & Hamilton, Barton H., 2000. "Hospital mergers and acquisitions: does market consolidation harm patients?," Journal of Health Economics, Elsevier, vol. 19(5), pages 767-791, September.
    12. Pinelopi Koujianou Goldberg, 2010. "Alfred Marshall Lecture Intellectual Property Rights Protection in Developing Countries: The Case of Pharmaceuticals," Journal of the European Economic Association, MIT Press, vol. 8(2-3), pages 326-353, 04-05.
    13. Mark Duggan & Craig Garthwaite & Aparajita Goyal, 2016. "The Market Impacts of Pharmaceutical Product Patents in Developing Countries: Evidence from India," American Economic Review, American Economic Association, vol. 106(1), pages 99-135, January.
    14. Jishnu Das & Jeffrey Hammer, 2014. "Quality of Primary Care in Low-Income Countries: Facts and Economics," Annual Review of Economics, Annual Reviews, vol. 6(1), pages 525-553, August.
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    Cited by:

    1. Clara Calini & Alessandra Catenazzo & Elisabetta Iossa, 2025. "Using Multiple Tools to Enhance Competition in Public Procurement," CEIS Research Paper 594, Tor Vergata University, CEIS, revised 25 Feb 2025.
    2. Bernasconi, Mario, 2024. "Essays on labour economics and industrial organization," Other publications TiSEM c26b3dfe-a2d3-4c31-b0fc-f, Tilburg University, School of Economics and Management.
    3. William Maloney & Pablo Garriga & Marcela Meléndez & Raúl Morales & Charl Jooste & James Sampi & Jorge Thompson Araujo & Ekaterina Vostroknutova, "undated". "Latin America and the Caribbean Economic Review, April 2024 - Competition: The Missing Ingredient for Growth? [Informe Económico América Latina y el Caribe, Abril 2024: Competencia: ¿el ingrediente que falta para crecer?]," World Bank Publications - Reports 41230, The World Bank Group.
    4. repec:wbk:wbrwps:10269 is not listed on IDEAS

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