No abstract

We exploit lottery wins to investigate the effects of exogenous changes to individuals' income on health care demand in the United Kingdom. This strategy allows us to estimate lottery income elasticities for a range of health care services that are publicly and privately provided. The results indicate that lottery winners with larger wins are more likely to choose private health services than public health services from the National Health Service. The positive effect of wins on the choice of private care is driven largely by winners with medium to large winnings (win category > $500 (or US$750); mean = $1922:5 (US$2,893.5), median = $1058:2 (US$1592.7)). For privately-insured individuals, larger winners are more likely to obtain private care for dental services and for eye, blood pressure, and cervical examinations. For individuals without private insurance, lottery wins have no effect on the choice of public or private care. We find that medium to big winners are more likely to have private medical insurance. Large winners are also more likely to drop coverage earlier, possibly after their winnings have been exhausted. The elasticities with respect to lottery wins are comparable in magnitude to the elasticities of household income from fixed effect models.

This paper investigates the contribution of public investment to the reduction of regional inequalities, with a specific application to Mexico. We use quantile regressions to examine the impact of public investment on regional disparities according to the position of each region in the conditional distribution of regional income. Results confirm the hypothesis that regional inequalities can indeed be attributed to the regional distribution of public investment, where the observed pattern shows that public investment mainly helped to reduce regional inequalities between the richest regions. JEL classification: R11, H50, C39Key words: regional development, public investment, quantile regression Resum: Aquest article examina la contribució de la inversió pública en la reducció de les desigualats regionals, amb una aplicació específica Mèxic. Utilitzem la regressió quantílica per examinar l'impacte de la inversió pública en reduir les disparitats regional dependent de la posició de cada regió en la distribució condicional de la renda regional. Els resultants confirmen la hipòtesi pel la qual les desigualtats regional poden atribuir-se a la distribució de la inversió pública de manera que ha contribuït a reduir les desigualtats entre les regions més riques.

more, regulatory requirements stipulate that a new orphan status application must be submitted for each indication. Under EMA regulations, orphan and nonorphan indications cannot be granted under the same marketing authorization. Although expansions between orphan and non-orphan indications are more common in the US, no examples of expansion from a non-orphan to orphan indication were identified by the authors. CONCLUSIONS: While indication expansion between orphan indications is relatively common, examples of expansion into or out of orphan indications are less frequent due to the regulatory restrictions. Pricing and reimbursement dynamics in all cases are reflective of the trade-offs between price potential and population size across indications. OBJECTIVES:Korea introduced a new positive list system in 2007 together with a price negotiation procedure. Importantly, these two systems are run by two different, independent organizations, namely the Health Insurance Review & Assessment Service (HIRA) and the National Health Insurance Corporation (NHIC). HIRA reviews the cost-effectiveness data in submissions and makes listing decisions, then NHIC takes over and sets the reimbursement price via negotiations with manufacturers. The aim of this study is to compare the difference in price after cost-effectiveness appraisal by HIRA and price negotiation by NHIC, and to analyze the factors that NHIC has considered to determine the reimbursement price. METHODS: All 35 submissions made to the NHIC between August 2007 and June 2008 were reviewed. 19 submissions concluded with agreement, 15 failed and one case was suspended. In this review only 15 cases of successful negotiations were included. The level of the reimbursement price compared to the submitted price for both essential drugs and non-essential ones and factors affecting the final price were analyzed. RESULTS: The discrepancy between reimbursement price and costeffective price was about 12.33Ϯ11.44% on average. For 3 essential drugs, the price level was almost equal to the submitted price whereas the average level was 84.94 Ϯ11.21% of the cost-effective price for non-essential drugs. The major factors affecting negotiations to determine the final price were narrowed down to total cost of substitutes, the foreign price, and the pharmaceutical budget impact. CONCLUSIONS: Our findings have demonstrated that drug pricing within the new environment has been done independently of cost-effectiveness appraisal. The payer has exhibited limited bargaining power for essential drugs. Overall, 87.67% of the cost-effective price was accepted during price negotiations, and the total cost of substitutes, foreign prices and pharmaceutical budget impact were considered equally when fixing the reimbursement price. A limitation of this study is that the result may not be generalized because of insufficient cases. OBJECTIVES:Most OECD countries employ pricing controls to contain rising health care expenditures. The recent financial crisis has resulted in further pressure to A336