The Changing Role of Government in Financing Health Care: An International Perspective

Stabile, Mark; Thomson, Sarah

doi:10.1257/jel.52.2.480

Cited by 44 publications

(9 citation statements)

References 81 publications

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“…Many EU governments also retain the right to block large price increases for prescription drugs, including generics, if necessary to protect public health or reduce pressure on the public purse . As nearly all EU countries have universal health care systems, funded either through government tax revenues or taxes on employers and employees, a population‐based focus has strong political support from consumers and nonindustry stakeholders in these nations …”

Section: Resultsmentioning

confidence: 99%

Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending

2017

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Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States.Regulators should make it easier for generic drugs to reach the market.Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use.To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. ContextRising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs.MethodsWe compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer‐reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study.FindingsThe prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off‐patent products. There are policy solutions to address issues in Europe and the United States, such as streamlining the generic drug approval process and requiring generic prescribing and substitution where such policies are not yet in place. The history of substitution laws in the United States provides insights into the economic, political, and cultural issues influencing the adoption of generic drug policies.ConclusionsGovernments should apply coherent supply‐ and demand‐side policies in generic drug markets. An immediate priority is to convince more physicians, pharmacists, and patients that generic drugs are bioequivalent to branded products. Special‐interest groups continue to obstruct reform in Europe and the United States.

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Section: Resultsmentioning

confidence: 99%

Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending

2017

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“…Yet analysis of healthcare resource allocation would help to evaluate the impact of China’s health system reforms. For example, we know that recent health finance initiatives have transformed how healthcare is paid for: between 2001 and 2013, the share of public and social funds in healthcare financing increased from 40 to 66.1 %, bringing out-of-pocket spending close to levels observed in OECD countries [15]. A plausible hypothesis is that non-economic factors, including geographical barriers, have consequently become more important in determining healthcare access.…”

Section: Introductionmentioning

confidence: 99%

Geographic distribution of hospital beds throughout China: a county-level econometric analysis

Pan

Shallcross

2016

Int J Equity Health

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BackgroundGeographical distribution of healthcare resources is an important dimension of healthcare access. Little work has been published on healthcare resource allocation patterns in China, despite public equity concerns.MethodsUsing national data from 2043 counties, this paper investigates the geographic distribution of hospital beds at the county level in China. We performed Gini coefficient analysis to measure inequalities and ordinary least squares regression with fixed provincial effects and additional spatial specifications to assess key determinants.ResultsWe found that provinces in west China have the least equitable resource distribution. We also found that the distribution of hospital beds is highly spatially clustered. Finally, we found that both county-level savings and government revenue show a strong positive relationship with county level hospital bed density.ConclusionsWe argue for more widespread use of disaggregated, geographical data in health policy-making in China to support the rational allocation of healthcare resources, thus promoting efficiency and equity.

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“…See also Wagstaff et al. () and Stabile and Thomson () for some of the financing issues involved in medical care and Campbell, Ikegami and Gibson () for international issues related to long‐term care.…”

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confidence: 99%

Medical Spending around the Developed World

French

Kelly

2016

Fiscal Studies

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We bring together estimates of patterns of medical spending in all nine countries considered in this issue -Canada, Denmark, England, France, Germany, Japan, the Netherlands, Taiwan and the United States. Comparing estimates across countries reveals three principal findings. First, medical spending in the calendar year of death accounts for 5-10 per cent of aggregate medical spending for the whole population and 9-20 per cent for those aged 65 and over. Spending in Taiwan is a little higher, at 16 per cent for the whole population and 29 per cent for the over-65s. Second, there is a mostly negative correlation between patient income and medical spending within all countries, except Japan and Taiwan for the over-65s and Taiwan and the US for the under-25s. Third, medical spending in all countries is concentrated in a small share of the population and is persistent over time, although the degree of concentration and persistence varies across countries. 328Fiscal Studies Policy pointsr Medical spending on those in the last year of life is costly, and accounts for 5-10 per cent of total medical spending. This cost is not trivial but is smaller than figures that have been suggested in the past.r The (mostly) negative correlation between income and medical spending within all countries suggests that medical systems typically act to redistribute resources from the rich to the poor. Changes in medical coverage and provision may therefore have distributional consequences.r Perhaps surprisingly, the United States is not an outlier in patterns of individual-level medical spending in the same way that it is in levels of spending as a share of GDP. Health care spending is somewhat less concentrated in the US than in most countries, and is less concentrated at the end of life than in most countries.

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The Changing Role of Government in Financing Health Care: An International Perspective

Cited by 44 publications

References 81 publications

Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending

Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending

Geographic distribution of hospital beds throughout China: a county-level econometric analysis

Medical Spending around the Developed World

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