IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/16854.html
   My bibliography  Save this paper

Does Price Reveal Poor-Quality Drugs? Evidence from 17 Countries

Author

Listed:
  • Roger Bate
  • Ginger Zhe Jin
  • Aparna Mathur

Abstract

Focusing on 8 drug types on the WHO-approved medicine list, we constructed an original dataset of 899 drug samples from 17 low- and median-income countries and tested them for visual appearance, disintegration, and analyzed their ingredients by chromatography and spectrometry. Fifteen percent of the samples fail at least one test and can be considered substandard. After controlling for local factors, we find that failing drugs are priced 13.6-18.7% lower than non-failing drugs but the signaling effect of price is far from complete, especially for non-innovator brands. The look of the pharmacy, as assessed by our covert shoppers, is weakly correlated with the results of quality tests. These findings suggest that consumers are likely to suspect low quality from market price, non-innovator brand and the look of the pharmacy, but none of these signals can perfectly identify substandard and counterfeit drugs. Indeed, many cheaper non-innovator products pass all quality tests, and are genuine generic drugs.

Suggested Citation

  • Roger Bate & Ginger Zhe Jin & Aparna Mathur, 2011. "Does Price Reveal Poor-Quality Drugs? Evidence from 17 Countries," NBER Working Papers 16854, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:16854
    Note: IO
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w16854.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Carl Shapiro, 1982. "Consumer Information, Product Quality, and Seller Reputation," Bell Journal of Economics, The RAND Corporation, vol. 13(1), pages 20-35, Spring.
    2. Ginger Zhe Jin & Andrew Kato, 2006. "Price, quality, and reputation: evidence from an online field experiment," RAND Journal of Economics, RAND Corporation, vol. 37(4), pages 983-1005, December.
    3. Richard G. Frank & David S. Salkever, 1997. "Generic Entry and the Pricing of Pharmaceuticals," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 6(1), pages 75-90, March.
    4. John A. Rizzo & Richard Zeckhauser, 2005. "Generic Scrip Share and the Price of Brand-Name Drugs: The Role of the Consumer," NBER Working Papers 11431, National Bureau of Economic Research, Inc.
    5. Grossman, Gene M & Shapiro, Carl, 1988. "Counterfeit-Product Trade," American Economic Review, American Economic Association, vol. 78(1), pages 59-75, March.
    6. John Rizzo & Richard Zeckhauser, 2009. "Generic script share and the price of brand-name drugs: the role of consumer choice," International Journal of Health Economics and Management, Springer, vol. 9(3), pages 291-316, September.
    7. Lanjouw, Jean O. & Cockburn, Iain M., 2001. "New Pills for Poor People? Empirical Evidence after GATT," World Development, Elsevier, vol. 29(2), pages 265-289, February.
    8. Danzon, Patricia M & Chao, Li-Wei, 2000. "Does Regulation Drive out Competition in Pharmaceutical Markets?," Journal of Law and Economics, University of Chicago Press, vol. 43(2), pages 311-357, October.
    9. Yi Qian, 2008. "Impacts of Entry by Counterfeiters," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 123(4), pages 1577-1609.
    10. Asher Wolinsky, 1983. "Prices as Signals of Product Quality," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 50(4), pages 647-658.
    11. Bohumir Pazderka, 1999. "Patent Protection and Pharmaceutical R&D Spending in Canada," Canadian Public Policy, University of Toronto Press, vol. 25(1), pages 29-46, March.
    12. Stigler, George J., 2011. "Economics of Information," Ekonomicheskaya Politika / Economic Policy, Russian Presidential Academy of National Economy and Public Administration, vol. 5, pages 35-49.
    13. Gene M. Grossman & Carl Shapiro, 1988. "Foreign Counterfeiting of Status Goods," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 103(1), pages 79-100.
    14. Danzon, Patricia M. & Chao, Li-Wei, 2000. "Cross-national price differences for pharmaceuticals: how large, and why?," Journal of Health Economics, Elsevier, vol. 19(2), pages 159-195, March.
    15. Klein, Benjamin & Leffler, Keith B, 1981. "The Role of Market Forces in Assuring Contractual Performance," Journal of Political Economy, University of Chicago Press, vol. 89(4), pages 615-641, August.
    16. Grabowski, Henry G & Vernon, John M, 1992. "Brand Loyalty, Entry, and Price Competition in Pharmaceuticals after the 1984 Drug Act," Journal of Law and Economics, University of Chicago Press, vol. 35(2), pages 331-350, October.
    17. Anis, Aslam H. & Wen, Quan, 1998. "Price regulation of pharmaceuticals in Canada," Journal of Health Economics, Elsevier, vol. 17(1), pages 21-38, January.
    18. Russell Cooper & Thomas W. Ross, 1984. "Prices, Product Qualities and Asymmetric Information: The Competitive Case," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 51(2), pages 197-207.
    19. Ginger Zhe Jin & Andrew Kato, 2006. "Price, quality, and reputation: evidence from an online field experiment," RAND Journal of Economics, The RAND Corporation, vol. 37(4), pages 983-1005, December.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Arzi Adbi & Ajay Bhaskarabhatla & Chirantan Chatterjee, 2020. "Stakeholder Orientation and Market Impact: Evidence from India," Journal of Business Ethics, Springer, vol. 161(2), pages 479-496, January.
    2. Ma, Xingliang & Spielman, David J. & Nazli, Hina & Zambrano, Patricia & Zaidi, Fatima & Kouser, Shahzad, 2014. "Information efficiency in a lemons market: Evidence from Bt cotton seed market in Pakistan," 2014 Annual Meeting, July 27-29, 2014, Minneapolis, Minnesota 175278, Agricultural and Applied Economics Association.
    3. Svensson, Jakob & Björkman Nyqvist, Martina & Yanagizawa-Drott, David, 2012. "Can Good Products Drive Out Bad? Evidence from Local Markets for (Fake?) Antimalarial Medicine in Uganda," CEPR Discussion Papers 9114, C.E.P.R. Discussion Papers.
    4. Roger Bate & Ginger Zhe Jin & Aparna Mathur, 2012. "In Whom We Trust: The Role of Certification Agencies in Online Drug Markets," NBER Working Papers 17955, National Bureau of Economic Research, Inc.
    5. Roger Bate & Ginger Zhe Jin & Aparna Mathur, 2015. "Falsified or Substandard? Assessing Price and Non‐price Signals of Drug Quality," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 24(4), pages 687-711, October.
    6. Adrienne M. Lucas & Nicholas L. Wilson, 2018. "Can At-Scale Drug Provision Improve the Health of the Targeted in Sub-Saharan Africa?," American Journal of Health Economics, MIT Press, vol. 4(3), pages 358-382, Summer.
    7. Esther Atukunda & Anne Fitzpatrick, 2015. "An Evaluation of Factors Affecting Drug Quality: Evidence from the Antimalarial Market in Uganda," Working Papers 2015_03, University of Massachusetts Boston, Economics Department.
    8. Roger Bate & Ginger Zhe Jin & Aparna Mathur, 2012. "Counterfeit or Substandard? Assessing Price and Non-Price Signals of Drug Quality," NBER Working Papers 18073, National Bureau of Economic Research, Inc.
    9. Levaggi, Rosella & Marcantoni, Claudio & Filippucci, Laura & Gelatti, Umberto, 2012. "Not a good buy: Value for money of prescription drugs sold on the Internet," Health Policy, Elsevier, vol. 106(3), pages 241-245.
    10. Barenji, Reza Vatankhah & Hariry, Reza Ebrahimi & Demirkol, Denizhan & Daim, Tugrul U., 2024. "Research landscape analysis for quality in Pharma 4.0 era," Technology in Society, Elsevier, vol. 76(C).
    11. Chatterjee, Chirantan & Mohapatra, Debi Prasad & Estay, Manuel, 2019. "From courts to markets: New evidence on enforcement of pharmaceutical bans in India," Social Science & Medicine, Elsevier, vol. 237(C), pages 1-1.
    12. Bate Roger & Jin Ginger Zhe & Mathur Aparna, 2013. "In Whom We Trust: The Role of Certification Agencies in Online Drug Markets," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 14(1), pages 111-150, December.
    13. Nicholas Wilson, 2015. "Can Disease-Specific Funding Harm Health? in the Shadow of HIV/AIDS Service Expansion," Demography, Springer;Population Association of America (PAA), vol. 52(5), pages 1671-1700, October.
    14. Roger Bate & Ginger Zhe Jin & Aparna Mathur & Amir Attaran, 2014. "Poor Quality Drugs and Global Trade: A Pilot Study," NBER Working Papers 20469, National Bureau of Economic Research, Inc.
    15. Lin, Yu-Shiuan & Lin, Min-Ting & Cheng, Shou-Hsia, 2019. "Drug price, dosage and safety: Real-world evidence of oral hypoglycemic agents," Health Policy, Elsevier, vol. 123(12), pages 1221-1229.
    16. Daniel Bennett & Wesley Yin, 2014. "The Market for High-Quality Medicine," NBER Working Papers 20091, National Bureau of Economic Research, Inc.
    17. Nunes, Alexandre Morais & Ferreira, Diogo Cunha & de Matos, Andreia & Julião, Rui Miranda, 2020. "The Portuguese generic medicines market: What’s next?," Health Policy, Elsevier, vol. 124(4), pages 397-403.
    18. Rafael Alfonso-Cristancho & Tatiana Andia & Tatiana Barbosa & Jonathan Watanabe, 2015. "Definition and Classification of Generic Drugs Across the World," Applied Health Economics and Health Policy, Springer, vol. 13(1), pages 5-11, August.
    19. Fitzpatrick, Anne, 2023. "Which price is right? A comparison of three standard approaches to measuring prices," Journal of Development Economics, Elsevier, vol. 163(C).
    20. Dai, Rong & Watal, Jayashree, 2021. "Product patents and access to innovative medicines," Social Science & Medicine, Elsevier, vol. 291(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jie Bai, 2016. "Melons as Lemons: Asymmetric Information, Consumer Learning and Seller Reputation," Natural Field Experiments 00540, The Field Experiments Website.
    2. Patricia M. Danzon & Eric L. Keuffel, 2014. "Regulation of the Pharmaceutical-Biotechnology Industry," NBER Chapters, in: Economic Regulation and Its Reform: What Have We Learned?, pages 407-484, National Bureau of Economic Research, Inc.
    3. Joan Costa-i-Font & Alistair McGuire & Nebibe Varol, 2011. "Does Pharmaceutical Price Regulation Affect the Adoption of Generic Competition? Evidence from the OECD, 1999-2008," CESifo Working Paper Series 3441, CESifo.
    4. Patricia M. Danzon & Andrew W. Mulcahy & Adrian K. Towse, 2015. "Pharmaceutical Pricing in Emerging Markets: Effects of Income, Competition, and Procurement," Health Economics, John Wiley & Sons, Ltd., vol. 24(2), pages 238-252, February.
    5. Antonio Cabrales & Sergi Jiménez-Martín, 2007. "The Determinants of Pricing in Pharmaceuticals: Are U.S. prices really higher than those of Canada?," Working Papers 304, Barcelona School of Economics.
    6. Laura Alfaro & Cathy Bao & Maggie X. Chen & Junjie Hong & Claudia Steinwender, 2022. "Omnia Juncta in Uno*: foreign powers and trademark protection in Shanghai's concession era," CEP Discussion Papers dp1827, Centre for Economic Performance, LSE.
    7. Lee Branstetter & Chirantan Chatterjee & Matthew J. Higgins, 2016. "Regulation and welfare: evidence from paragraph IV generic entry in the pharmaceutical industry," RAND Journal of Economics, RAND Corporation, vol. 47(4), pages 857-890, November.
    8. Dubovik, Andrei & Janssen, Maarten C.W., 2012. "Oligopolistic competition in price and quality," Games and Economic Behavior, Elsevier, vol. 75(1), pages 120-138.
    9. Carlton, Dennis W. & Perloff, Jeffrey M., 1989. "The Economics of Information," Research Reports 25156, University of Connecticut, Food Marketing Policy Center.
    10. Michael Waldman, 1984. "The Role of Integrity in Economic Interaction," UCLA Economics Working Papers 350, UCLA Department of Economics.
    11. Antonio Cabrales & Sergi Jiménez‐Martín, 2013. "The Determinants Of Pricing In Pharmaceuticals: Are Us Prices Really So High?," Health Economics, John Wiley & Sons, Ltd., vol. 22(11), pages 1377-1397, November.
    12. Michael Luca & Oren Reshef, 2020. "The Effect of Price on Firm Reputation," NBER Working Papers 27405, National Bureau of Economic Research, Inc.
    13. Costa-Font, Joan & McGuire, Alistair & Varol, Nebibe, 2014. "Price regulation and relative delays in generic drug adoption," Journal of Health Economics, Elsevier, vol. 38(C), pages 1-9.
    14. Tin Cheuk Leung, 2013. "What Is the True Loss Due to Piracy? Evidence from Microsoft Office in Hong Kong," The Review of Economics and Statistics, MIT Press, vol. 95(3), pages 1018-1029, July.
    15. Hongbin Cai & Ginger Z. Jin & Chong Liu & Li-An Zhou, 2013. "More Trusting, Less Trust? An Investigation of Early E-Commerce in China," NBER Working Papers 18961, National Bureau of Economic Research, Inc.
    16. Nikolaus Thumm & Vincenzo Butticè & Federico Caviggioli & Chiara Franzoni & Giuseppe, Scellato, 2018. "Impact of counterfeiting on the performance of digital technology companies," JRC Working Papers on Digital Economy 2018-03, Joint Research Centre.
    17. Sotiris Vandoros, 2014. "Therapeutic Substitution Post‐Patent Expiry: The Cases Of Ace Inhibitors And Proton Pump Inhibitors," Health Economics, John Wiley & Sons, Ltd., vol. 23(5), pages 621-630, May.
    18. Wright, Donald J., 2004. "The drug bargaining game: pharmaceutical regulation in Australia," Journal of Health Economics, Elsevier, vol. 23(4), pages 785-813, July.
    19. Hu, Shu & Fu, Ke & Wu, Tong, 2021. "The role of consumer behavior and power structures in coping with shoddy goods," Transportation Research Part E: Logistics and Transportation Review, Elsevier, vol. 155(C).
    20. Gary Bolton & Ben Greiner & Axel Ockenfels, 2013. "Engineering Trust: Reciprocity in the Production of Reputation Information," Management Science, INFORMS, vol. 59(2), pages 265-285, January.

    More about this item

    JEL classification:

    • D18 - Microeconomics - - Household Behavior - - - Consumer Protection
    • D4 - Microeconomics - - Market Structure, Pricing, and Design
    • D8 - Microeconomics - - Information, Knowledge, and Uncertainty
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L15 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Information and Product Quality

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:nbr:nberwo:16854. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.