Has the shortened drug distribution chain cut drug prices? Evidence from the Two-Invoice System in China
中文摘要
全球对药价上涨的担忧促使制药行业出台旨在提升价格透明度与流通效率的监管举措。本研究考察中国两票制（TIS）的影响，该项2016年的改革旨在通过精简药品流通链条、增强价格透明度来降低药品成本。我们构建理论模型，考察药品制造商与经销商在定价与促销活动上的决策。我们预测其对药价存在相互竞争的两方面效应：一方面，因双重加价而被抬高的中间环节加成会下降；另一方面，高效经销商的移除可能推高供应链成本。我们采用交错双重差分方法，结合2015至2019年的采购数据，发现两票制的实施使药品平均价格上升了1.9%，与政策预期相反。价格上升在低价药品和较富裕地区更为明显，这些情形下供应链加成有限，效率受扰的效应可能占主导。我们还发现制造商的销售与营销费用显著增加，而这些制造商本应已承担了相当一部分此前由经销商承担的促销成本。这些发现凸显了监管改革带来的非预期低效，表明需要兼顾成本控制与医疗市场动态的平衡性政策设计。
Abstract
Global concerns over rising drug prices have led to regulatory efforts in the pharmaceutical industry targeting price transparency and distribution efficiency. This study examines the impact of China’s Two-Invoice System (TIS), a 2016 reform aimed at reducing drug costs by streamlining the pharmaceutical distribution chain and enhancing price transparency. With a theoretical model, we examine the decision-making for pharmaceutical manufacturers and distributors on pricing and promotion activities. We predict competing effects on drug prices: while intermediary markups inflated by double marginalization are reduced, the removal of efficient distributors may elevate supply chain expenses. Using a staggered difference-in-differences approach with procurement data from 2015 to 2019, we find that the implementation of TIS led to a 1.9% increase in average drug prices, contrary to policy expectations. Price increases were more pronounced for lower-priced drugs and in wealthier regions, for which the supply chain markups are limited and the effect of efficiency disruption might dominate. We also document a significant increase in sales and marketing expenses of the manufacturers, who are supposed to have absorbed a considerable amount of promotional costs previously borne by distributors. These findings underscore the unintended inefficiencies of regulatory reforms, highlighting the need for a balanced policy design that considers both cost control and market dynamics in healthcare.