处方药广告与药物使用：美国联邦医疗保险D部分的作用

中文摘要

本文利用美国联邦医疗保险D部分推出所引发的直接面向消费者的处方药广告（DTCA）大规模且可合理视为外生的冲击，考察DTCA如何影响药物使用。D部分使联邦医疗保险受益人集中度较高地区的广告投放增幅更大。我们考察这种广告投放差异化增长对非老年人的影响，以将广告效应与D部分的直接效应区分开来。我们发现，广告暴露使开始接受治疗的人数大幅增加，并改善了用药依从性。广告还对未被广告宣传的仿制药产生了规模可观的正向溢出效应。研究结果表明，美国联邦医疗保险D部分对65岁以下人群产生了重要的溢出效应，同时说明非价格因素在影响处方药使用方面发挥着重要作用。

Abstract

This paper examines how direct-to-consumer advertising (DTCA) for prescription drugs influences utilization by exploiting a large and plausibly exogenous shock to DTCA driven by the introduction of Medicare Part D. Part D led to larger increases in advertising in geographic areas with higher concentrations of Medicare beneficiaries. We examine the impact of this differential increase in advertising on non-elderly individuals to isolate advertising effects from the direct effects of Part D. We find that exposure to advertising led to large increases in treatment initiation and improved medication adherence. Advertising also had sizeable positive spillover effects on non-advertised generic drugs. Our results imply significant spillovers from Medicare Part D on the under-65 population and an important role for non-price factors in influencing prescription drug utilization.