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Can Medical Progress be Sustained? Implications of the Link Between Development and Output Markets

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  • Anup Malani
  • Tomas J. Philipson

Abstract

There is considerable debate about the impact of health care reform on the growth in medical spending. Medical innovation is thought to be a central contributor to that growth. We argue that there is a unique linkage between reforms that affect output markets for medical care and medical R&D costs. This linkage is due to the fact that potential consumers of medical care are also potential participants in clinical trials that are required to develop new medical products. Therefore, reforms that increase the quality or reduce the price of already developed treatments reduce the incentive of patients to participate in trials of experimental treatments. This delays development and reduce the returns to in innovation. We provide evidence of this "subject market effect" by considering the impact of changes in the quality of conventional care on development. We document a dramatic drop in trial recruitment following introduction of break-through HIV/AIDS therapies in 1996. We conclude by discussing additional positive and normative implications of the subject market effect that link input and output markets for medical products.

Suggested Citation

  • Anup Malani & Tomas J. Philipson, 2011. "Can Medical Progress be Sustained? Implications of the Link Between Development and Output Markets," NBER Working Papers 17011, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:17011
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    1. Sylvain Chassang & Gerard Padro I Miquel & Erik Snowberg, 2012. "Selective Trials: A Principal-Agent Approach to Randomized Controlled Experiments," American Economic Review, American Economic Association, vol. 102(4), pages 1279-1309, June.
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    6. Anup Malani, 2006. "Identifying Placebo Effects with Data from Clinical Trials," Journal of Political Economy, University of Chicago Press, vol. 114(2), pages 236-256, April.
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    9. Tomas Philipson & Larry V. Hedges, 1998. "Subject Evaluation in Social Experiments," Econometrica, Econometric Society, vol. 66(2), pages 381-408, March.
    10. Lakdawalla, Darius & Sood, Neeraj, 2013. "Health insurance as a two-part pricing contract," Journal of Public Economics, Elsevier, vol. 102(C), pages 1-12.
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    Cited by:

    1. Bognar, Katalin & Romley, John A. & Bae, Jay P. & Murray, James & Chou, Jacquelyn W. & Lakdawalla, Darius N., 2017. "The role of imperfect surrogate endpoint information in drug approval and reimbursement decisions," Journal of Health Economics, Elsevier, vol. 51(C), pages 1-12.
    2. Adam Leive & Thomas Stratmann, 2015. "Do national cancer screening guidelines reduce mortality?," Journal of Population Economics, Springer;European Society for Population Economics, vol. 28(4), pages 1075-1095, October.
    3. Barton H. Hamilton & Andrés Hincapié & Robert A. Miller & Nicholas W. Papageorge, 2021. "Innovation And Diffusion Of Medical Treatment," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 62(3), pages 953-1009, August.
    4. Eric Budish & Benjamin Roin & Heidi Williams, 2013. "Do fixed patent terms distort innovation? Evidence from cancer clinical trials," Discussion Papers 13-001, Stanford Institute for Economic Policy Research.
    5. Charles I. Jones, 2016. "Life and Growth," Journal of Political Economy, University of Chicago Press, vol. 124(2), pages 539-578.
    6. Lakdawalla, Darius & Malani, Anup & Reif, Julian, 2017. "The insurance value of medical innovation," Journal of Public Economics, Elsevier, vol. 145(C), pages 94-102.
    7. Kristopher J. Hult & Tomas J. Philipson, 2012. "Public Liabilities and Health Care Policy," NBER Working Papers 18571, National Bureau of Economic Research, Inc.
    8. Jeffrey Clemens, 2012. "The Effect of U.S. Health Insurance Expansions on Medical Innovation," Discussion Papers 11-016, Stanford Institute for Economic Policy Research.
    9. Eric Budish & Benjamin N. Roin & Heidi Williams, 2015. "Do Firms Underinvest in Long-Term Research? Evidence from Cancer Clinical Trials," American Economic Review, American Economic Association, vol. 105(7), pages 2044-2085, July.
    10. Darius N. Lakdawalla & Charles E. Phelps, 2019. "Evaluation of Medical Technologies with Uncertain Benefits," NBER Working Papers 26058, National Bureau of Economic Research, Inc.

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    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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