Summary
We assess the relative importance of demand and supply factors as determinants of regional variation in healthcare expenditures in the Netherlands. Our empirical approach follows individuals who migrate between regions. We use individual data on annual healthcare expenditures for the entire Dutch population between the years 2006 and 2013. Regional variation in healthcare expenditures is mostly driven by demand factors, with an estimated share of around 70%. The relative importance of different causes varies with the groups of regions being compared.
In the last two decades, many European countries allowed the sale of over‐the‐counter (OTC) drugs outside pharmacies. This was expected to lower retail prices through increased competition. Evidence of such price reductions is scarce. We assess the impact of supermarket and outlet entry in the OTC drug market on OTC prices charged by incumbent pharmacies using a difference‐in‐differences strategy. We use price data on five popular OTC drugs for all retailers located in Lisbon for three distinct points in time (2006, 2010, and 2015). Our results suggest that competitive pressure in the market is mainly exerted by supermarkets, which charge, on average, 20% lower prices than pharmacies. The entry of a supermarket among the main competitors of an incumbent pharmacy is associated with an average 4% to 6% decrease in prices relative to the control group. These price reductions are long‐lasting but fairly localized. We find no evidence of price reductions following OTC outlet entry. Additional results from a reduced‐form entry model and a propensity score matching difference‐in‐differences approach support the view that these effects are causal.
Introduction: The percentage of citizens who were not registered with a family physician in Portugal reached 16.6% in 2011. In 2012 the Ministry of Health implemented several measures aiming at improving access to family physicians. One clear objective was that all individuals would be registered with a family physician by 2014. We evaluate the evolution of the socioeconomic inequalities regarding registration with family physicians in Portugal between 2009 and 2014.Material and Methods: We use data at the primary health care unit level on the number of individuals who are not registered with a family physician and the purchasing power of the population served by each unit. The analysis is done using concentration measures.Results: We find a higher concentration of individuals not registered with a family physician among units serving populations with higher socioeconomic status, although this has been decreasing over the years analyzed. Amongst units serving the most disadvantaged populations, we find a situation close to perfect equality.Discussion: Our results may reflect the fact that populations with higher economic status live in urban areas where there is greater shortage of family physicians. Alternatively, it may be that these populations choose not to have a family physician within the public system, thus relying on private providers. Conclusion: Our findings convey a reduction in existing socioeconomic inequalities in terms of registration with a primary care physician, during the period under analysis. This reduction took place among the populations which experienced more inequality.
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