Reform-induced competition: Evaluating the impact on Swiss pharmacies and total drug costs
中文摘要
本文探讨了瑞士两个城市的制度变革(允许医生自行配药)所引发的竞争加剧对药店的影响。通过合并药店层面的详细销售数据与调查数据,双重差分估计显示,药店在处方药收入和利润方面的市场份额出现显著且永久性的损失。这一下降由用于急性疾病的药物所驱动,且在规模较大的药店中较不明显。仿制药销售显著下降,而价格更高的品牌药基本未受影响。我发现有证据表明,药店通过向健康服务领域多元化发展来应对竞争的加剧。加入行政医生数据后显示,该改革每年导致约1950万瑞士法郎的额外药品成本。我的研究结果表明,更多的竞争可能导致社会承担更高的药品成本。
Abstract
This paper explores the effect of increased competition on pharmacies induced by a regime change in two Swiss cities allowing physicians to self-dispense drugs. By merging detailed sales and survey data at the pharmacy level, a difference-in-differences estimation shows a significant and permanent loss of market share in prescribed drug revenue and profits. The decline is driven by drugs used for acute illnesses and is less pronounced for larger pharmacies. While generic drug sales decrease significantly, the more expensive brand-name drugs remain largely unaffected. I find evidence that pharmacies respond to increased competition by diversifying toward health services. Adding administrative physician data shows that the reform caused approximately CHF 19.5M in additional drug costs per year. My results demonstrate that more competition can result in higher drug costs for society.