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Subsidizing access to prescription drugs and health outcomes: The case of diabetes

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  • Américo, Pedro
  • Rocha, Rudi

Abstract

This paper evaluates the health effects of a large-scale subsidizing program of prescription drugs introduced in Brazil, the Aqui Tem Farmácia Popular program (ATFP). We exploit features of the program to identify its effects on mortality and hospitalization rates by diabetes for individuals aged 40 years or more. We find weak evidence for a decline in mortality, but a robust reduction in hospitalization rates. According to our preferred specification, an additional ATFP pharmacy per 100,000 inhabitants is associated with a decrease in hospitalization rates by diabetes of 8.2, which corresponds to 3.6% of its baseline rate. Effects are larger for Type II diabetes in comparison to Type I, and among patients with relatively lower socioeconomic status. Overall, the results are consistent with insulin-dependent patients being relatively less responsive to subsidies because of higher immediate life-threatening risks; and with lower-SES individuals being more responsive because of liquidity constraints. These results support the view that the optimal design of health systems and cost-sharing mechanisms should take into account equity concerns, heterogeneous impacts by health condition, and their potential offsetting effects on the utilization of downstream health services.

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  • Américo, Pedro & Rocha, Rudi, 2020. "Subsidizing access to prescription drugs and health outcomes: The case of diabetes," Journal of Health Economics, Elsevier, vol. 72(C).
    • Handle: RePEc:eee:jhecon:v:72:y:2020:i:c:s0167629619308434
    DOI: 10.1016/j.jhealeco.2020.102347
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    1. Chandra, Amitabh & Gruber, Jonathan & McKnight, Robin, 2014. "The impact of patient cost-sharing on low-income populations: Evidence from Massachusetts," Journal of Health Economics, Elsevier, vol. 33(C), pages 57-66.
    2. Paula Bustos & Bruno Caprettini & Jacopo Ponticelli, 2016. "Agricultural Productivity and Structural Transformation: Evidence from Brazil," American Economic Review, American Economic Association, vol. 106(6), pages 1320-1365, June.
    3. Dahlia K. Remler & Adam J. Atherly, 2003. "Health status and heterogeneity of cost‐sharing responsiveness: how do sick people respond to cost‐sharing?," Health Economics, John Wiley & Sons, Ltd., vol. 12(4), pages 269-280, April.
    4. Taryn Dinkelman, 2011. "The Effects of Rural Electrification on Employment: New Evidence from South Africa," American Economic Review, American Economic Association, vol. 101(7), pages 3078-3108, December.
    5. Abe Dunn & Adam Hale Shapiro, 2019. "Does Medicare Part D Save Lives?," American Journal of Health Economics, MIT Press, vol. 5(1), pages 126-164, Winter.
    6. Gaynor Martin & Li Jian & Vogt William B, 2007. "Substitution, Spending Offsets, and Prescription Drug Benefit Design," Forum for Health Economics & Policy, De Gruyter, vol. 10(2), pages 1-33, July.
    7. Robert Kaestner & Nasreen Khan, 2012. "Medicare Part D and Its Effect on the Use of Prescription Drugs and Use of Other Health Care Services of the Elderly," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 31(2), pages 253-279, March.
    8. Robert Kaestner & Cuping Schiman & G. Caleb Alexander, 2019. "Effects of Prescription Drug Insurance on Hospitalization and Mortality: Evidence from Medicare Part D," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 86(3), pages 595-628, September.
    9. Amitabh Chandra & Jonathan Gruber & Robin McKnight, 2010. "Patient Cost-Sharing and Hospitalization Offsets in the Elderly," American Economic Review, American Economic Association, vol. 100(1), pages 193-213, March.
    10. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 73-117.
    11. Huh, Jason & Reif, Julian, 2017. "Did Medicare Part D reduce mortality?," Journal of Health Economics, Elsevier, vol. 53(C), pages 17-37.
    12. Jaume Puig‐Junoy & Pilar García‐Gómez & David Casado‐Marín, 2016. "Free Medicines Thanks to Retirement: Impact of Coinsurance Exemption on Pharmaceutical Expenditures and Hospitalization Offsets in a national health service," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 750-767, June.
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    Cited by:

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    3. Aaron Barkley, 2023. "The Human Cost of Collusion: Health Effects of a Mexican Insulin Cartel," Journal of the European Economic Association, European Economic Association, vol. 21(5), pages 1865-1904.
    4. Stefan Sliwa Ruiz & Malte Becker & Thomas Hone & Rudi Rocha, 2023. "Doctor Turnover and Health Outcomes: Evidence from the Exit of Cuban Doctors in Brazil," Working Papers 18, Instituto de Estudos para Políticas de Saúde.
    5. Cici McNamara & Natalia Serna, 2022. "The impact of a national formulary expansion on diabetics," Health Economics, John Wiley & Sons, Ltd., vol. 31(11), pages 2311-2332, November.

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    More about this item

    Keywords

    Subsidies; Prescription drugs; Diabetes; Hospital admissions; Mortality;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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