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Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada

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  • Paul Contoyannis
  • Jeremiah Hurley
  • Paul Grootendorst
  • Sung-Hee Jeon
  • Robyn Tamblyn

    (Department of Epidemiology and Biostatistics, McGill University, Canada)

Abstract

The price elasticity of demand for prescription drugs is a crucial parameter of interest in designing pharmaceutical benefit plans. Estimating the elasticity using micro-data, however, is challenging because insurance coverage that includes deductibles, co-insurance provisions and maximum expenditure limits create a non-linear price schedule, making price endogenous (a function of drug consumption). In this paper we exploit an exogenous change in cost-sharing within the Quebec (Canada) public Pharmacare program to estimate the price elasticity of expenditure for drugs using IV methods. This approach corrects for the endogeneity of price and incorporates the concept of a 'rational' consumer who factors into consumption decisions the price they expect to face at the margin given their expected needs. The IV method is adapted from an approach developed in the public finance literature used to estimate income responses to changes in tax schedules. The instrument is based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. Our preferred specification leads to expenditure elasticities that are in the low range of previous estimates (between −0.12 and −0.16). Naïve OLS estimates are between 1 and 4 times these magnitudes. Copyright © 2005 John Wiley & Sons, Ltd.

Suggested Citation

  • Paul Contoyannis & Jeremiah Hurley & Paul Grootendorst & Sung-Hee Jeon & Robyn Tamblyn, 2005. "Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 909-923.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:9:p:909-923
    DOI: 10.1002/hec.1041
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    References listed on IDEAS

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    Cited by:

    1. Merja Halme & Kari Linden & Kimmo Kääriä, 2009. "Patients’ Preferences for Generic and Branded Over-the-Counter Medicines," The Patient: Patient-Centered Outcomes Research, Springer;Johns Hopkins Bloomberg School of Public Health, vol. 2(4), pages 243-255, December.
    2. Marianne Simonsen & Lars Skipper & Niels Skipper, 2016. "Price Sensitivity of Demand for Prescription Drugs: Exploiting a Regression Kink Design," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 31(2), pages 320-337, March.
    3. Dalen Dag Morten & Locatelli Marilena & Sorisio Enrico & Strom Steinar, 2011. "A Probability Approach to Pharmaceutical Demand and Price Setting: Does the Identity of the Third-Party Payer Matters for Prescribing Doctors?," Department of Economics and Statistics Cognetti de Martiis. Working Papers 201110, University of Turin.
    4. Manuel Coutinho Pereira & Hugo Vilares, 2014. "A review of the pharmaceutical market in Portugal," Economic Bulletin and Financial Stability Report Articles, Banco de Portugal, Economics and Research Department.
    5. Wang, Chao & Li, Qing & Sweetman, Arthur & Hurley, Jeremiah, 2015. "Mandatory universal drug plan, access to health care and health: Evidence from Canada," Journal of Health Economics, Elsevier, vol. 44(C), pages 80-96.
    6. Fiorio, Carlo V. & Siciliani, Luigi, 2010. "Co-payments and the demand for pharmaceuticals: Evidence from Italy," Economic Modelling, Elsevier, vol. 27(4), pages 835-841, July.
    7. Skipper, Niels, 2012. "On reimbursement reforms and stockpiling of prescription drugs: The case of insulin," Health Policy, Elsevier, vol. 106(3), pages 233-240.
    8. Chad D. Meyerhoefer & Samuel H. Zuvekas, 2010. "New estimates of the demand for physical and mental health treatment," Health Economics, John Wiley & Sons, Ltd., vol. 19(3), pages 297-315.
    9. Sergei Koulayev & Niels Skipper & Emilia Simeonova, 2013. "Who Is in Control? The Determinants of Patient Adherence with Medication Therapy," NBER Working Papers 19496, National Bureau of Economic Research, Inc.
    10. Brekke, Kurt R. & Grasdal, Astrid L. & Holms, Tor Helge, 2009. "Regulation and pricing of pharmaceuticals: Reference pricing or price cap regulation?," European Economic Review, Elsevier, vol. 53(2), pages 170-185, February.
    11. Laura González & Giuliano Masiero, 2011. "Disentangling spillover effects of antibiotic consumption: a spatial panel approach," Quaderni della facoltà di Scienze economiche dell'Università di Lugano 1106, USI Università della Svizzera italiana.
    12. Paul Grootendorst, 2012. "Prescription Drug Insurance and Reimbursement," Chapters,in: The Elgar Companion to Health Economics, Second Edition, chapter 11 Edward Elgar Publishing.
    13. Kai Yeung & Anirban Basu & Ryan N. Hansen & Sean D. Sullivan, 2016. "Price Elasticities of Pharmaceuticals in a Value-Based-Formulary Setting," NBER Working Papers 22308, National Bureau of Economic Research, Inc.
    14. Kurt Brekke & Dag Dalen & Tor Holmås, 2014. "Diffusion of pharmaceuticals: cross-country evidence of anti-TNF drugs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 937-951, December.
    15. Niels Skipper, 2010. "On Utilization and Stockpiling of Prescription Drugs when Co-payments Increase: Heterogeneity across Types of Drugs," Economics Working Papers 2010-12, Department of Economics and Business Economics, Aarhus University.
    16. Helmut Farbmacher & Peter Ihle & Ingrid Schubert & Joachim Winter & Amelie Wuppermann, 2017. "Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1234-1248, October.
    17. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    18. Dalen, Dag Morten & Sorisio, Enrico & Strøm, Steinar, 2009. "Choosing among Competing Blockbusters: Does the Identity of the Third-party Payer Matter for Prescribing Doctors?," Memorandum 10/2009, Oslo University, Department of Economics.
    19. Li, Xin & Guh, Daphne & Lacaille, Diane & Esdaile, John & Anis, Aslam H., 2007. "The impact of cost sharing of prescription drug expenditures on health care utilization by the elderly: Own- and cross-price elasticities," Health Policy, Elsevier, vol. 82(3), pages 340-347, August.

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