Impact de la réforme de l’assurance maladie en Tunisie sur l’offre et la demande des médicaments

This thesis proposes to determine the effect of the Health insurance reform in Tunisia on pharmaceutical demand and supply. For this purpose, we present the main characteristics of the Tunisian pharmaceutical market, with describing the objectives and modalities of implementation of Health insurance reform (Chapter 1). Then we demonstrate empirically the importance of generic competition (Chapter 2). Finally, we determine the impact of the Health insurance reform, specifically the introduction of reference price system on prices and market shares of four selected molecules (Chapter 3). It has information on prices and quantities of four selected molecules (eleven different presentations) from the third quarter 2002 to the fourth quarter 2008. In the first chapter, we specify the Tunisian Health care system, with explaining the characteristics of the pharmaceutical market. Then, we describe the Health insurance system, the reform objectives, particularly, on pharmaceuticals. And we define the reference price system and the modalities for its implementation. In the second chapter, we study the effect of the generic competition on prices and market shares. We find that the presence of generic products on the pharmaceutical market, offers the possibility to switch for the cheaper one. In addition, we find that the brand name price’s drop intensely than the average price of generic. Moreover, it seems that the decrease of the generic-to-brand price ratio entails an increase (decrease) in market share of generics (brand name’s drug). This increase in market share of generics is attributed to price changes. In addition, the empirical results suggest that the generic share depends on, and is influenced by, generic price. In addition, we find the number of generic entrants to be a key determinant of the level of generics’ share and generic-to-brand price ratio. In the third chapter, we examine the effect of the introduction of Reference pricing (RP) on price. It shows that the brand name’s price decline after the imposition of reform and the introduction of reference pricing, and generic competition plays an important role in this process. We find that the reference price system has a strong effect of reducing prices of pharmaceuticals under this regime; the effect is stronger for brand name than generic versions. This confirms that the RP encourages competition. The reference pricing system induces a change in the market for medicines to generic versions.