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Physician Agency and the Zero‐Markup Drug Policy in China: Evidence From a Structural Model

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  • Qifan Huang
  • Zhentong Lu
  • Castiel Chen Zhuang

Abstract

This paper quantifies physician agency in China's prescription drug market by exploiting the structural shift created by the Zero‐Markup Drug Policy. We find that physicians' prescribing decisions are about three times more sensitive to the hospital's profit margin than to the retail price faced by patients. The study provides several key findings. First, government policy exerts a strong influence on drug prices. Second, branded drugs are generally preferred over generics and display lower price elasticity. Third, the policy accounts for more than half of the observed decline in average wholesale prices. Finally, while the policy improves patient welfare, it reduces pharmaceutical firms' sales and profits, and a partial restoration of drug markups could increase overall social welfare.

Suggested Citation

  • Qifan Huang & Zhentong Lu & Castiel Chen Zhuang, 2026. "Physician Agency and the Zero‐Markup Drug Policy in China: Evidence From a Structural Model," Health Economics, John Wiley & Sons, Ltd., vol. 35(4), pages 653-676, April.
  • Handle: RePEc:wly:hlthec:v:35:y:2026:i:4:p:653-676
    DOI: 10.1002/hec.70073
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    References listed on IDEAS

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    1. Fu, Hongqiao & Li, Ling & Yip, Winnie, 2018. "Intended and unintended impacts of price changes for drugs and medical services: Evidence from China," Social Science & Medicine, Elsevier, vol. 211(C), pages 114-122.
    2. Jonas Björnerstedt & Frank Verboven, 2016. "Does Merger Simulation Work? Evidence from the Swedish Analgesics Market," American Economic Journal: Applied Economics, American Economic Association, vol. 8(3), pages 125-164, July.
    3. Gautam Gowrisankaran & Aviv Nevo & Robert Town, 2015. "Mergers When Prices Are Negotiated: Evidence from the Hospital Industry," American Economic Review, American Economic Association, vol. 105(1), pages 172-203, January.
    4. Minjae Song & Sean Nicholson & Claudio Lucarelli, 2017. "Mergers with interfirm bundling: a case of pharmaceutical cocktails," RAND Journal of Economics, RAND Corporation, vol. 48(3), pages 810-834, August.
    5. Pakes, Ariel, 2017. "Empirical tools and competition analysis: Past progress and current problems," International Journal of Industrial Organization, Elsevier, vol. 53(C), pages 241-266.
    6. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    7. Lu, Fangwen, 2014. "Insurance coverage and agency problems in doctor prescriptions: Evidence from a field experiment in China," Journal of Development Economics, Elsevier, vol. 106(C), pages 156-167.
    8. Henrick Horn & Asher Wolinsky, 1988. "Bilateral Monopolies and Incentives for Merger," RAND Journal of Economics, The RAND Corporation, vol. 19(3), pages 408-419, Autumn.
    9. Dubois, Pierre & Gandhi, Ashvin & Vasserman, Shoshana, 2022. "Bargaining and International Reference Pricing in the Pharmaceutical Industry," CEPR Discussion Papers 17293, Centre for Economic Policy Research.
    10. Ching, Andrew T., 2010. "Consumer learning and heterogeneity: Dynamics of demand for prescription drugs after patent expiration," International Journal of Industrial Organization, Elsevier, vol. 28(6), pages 619-638, November.
    11. Toshiaki Iizuka, 2007. "Experts' agency problems: evidence from the prescription drug market in Japan," RAND Journal of Economics, RAND Corporation, vol. 38(3), pages 844-862, September.
    12. Kate Ho & Ariel Pakes, 2014. "Hospital Choices, Hospital Prices, and Financial Incentives to Physicians," American Economic Review, American Economic Association, vol. 104(12), pages 3841-3884, December.
    13. Matthew Grennan, 2013. "Price Discrimination and Bargaining: Empirical Evidence from Medical Devices," American Economic Review, American Economic Association, vol. 103(1), pages 145-177, February.
    14. Steven T. Berry, 1994. "Estimating Discrete-Choice Models of Product Differentiation," RAND Journal of Economics, The RAND Corporation, vol. 25(2), pages 242-262, Summer.
    15. Gregory S. Crawford & Ali Yurukoglu, 2012. "The Welfare Effects of Bundling in Multichannel Television Markets," American Economic Review, American Economic Association, vol. 102(2), pages 643-685, April.
    16. Amil Petrin, 2002. "Quantifying the Benefits of New Products: The Case of the Minivan," Journal of Political Economy, University of Chicago Press, vol. 110(4), pages 705-729, August.
    17. Thomas G. Wollmann, 2018. "Trucks without Bailouts: Equilibrium Product Characteristics for Commercial Vehicles," American Economic Review, American Economic Association, vol. 108(6), pages 1364-1406, June.
    18. Ernst R. Berndt & Robert S. Pindyck & Pierre Azoulay, 2003. "Consumption Externalities and Diffusion in Pharmaceutical Markets: Antiulcer Drugs," Journal of Industrial Economics, Wiley Blackwell, vol. 51(2), pages 243-270, June.
    19. Andrew T. Ching, 2010. "A Dynamic Oligopoly Structural Model For The Prescription Drug Market After Patent Expiration," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 51(4), pages 1175-1207, November.
    20. Steven Berry & Panle Jia, 2010. "Tracing the Woes: An Empirical Analysis of the Airline Industry," American Economic Journal: Microeconomics, American Economic Association, vol. 2(3), pages 1-43, August.
    21. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, vol. 18(4), pages 473-490, August.
    22. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, vol. 26(2), pages 281-298, April.
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