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Most countries regulate pharmaceutical prices, either directly or indirectly, on the assumption that competition is at best weak in this industry. This paper tests the hypothesis that regulation of manufacturer prices and retail pharmacy margins undermines price competition. We use data from seven countries for 1992 to examine price competition between generic competitors (different manufacturers of the same compound) and therapeutic substitutes (similar compounds) under different regulatory regimes. We find that price competition between generic competitors is significant in unregulated or less regulated markets (United States, United Kingdom, Canada, and Germany) but that regulation undermines generic competition in strict regulatory systems (France, Italy, and Japan). Regulation of retail pharmacy further constrains competition in France, Germany, and Italy. Regulation thus undermines the potential for significant savings on off-patent drugs, which account for a large and growing share of drug expenditures. Evidence of competition between therapeutic substitutes is less conclusive owing to data limitations. DisciplinesAccessibility | Education Economics AbstractMost countries regulate pharmaceutical prices, either directly or indirectly, on the assumption that competition is at best weak in this industry. This paper tests the hypothesis that regulation of manufacturer prices and retail pharmacy margins undermines price competition. We use data from seven countries for 1992 to examine price competition between generic competitors (different manufacturers of the same compound) and therapeutic substitutes (similar compounds) under different regulatory regimes. We find that price competition between generic competitors is significant in unregulated or less regulated markets (United States, United Kingdom, Canada, and Germany) but that regulation undermines generic competition in strict regulatory systems (France, Italy, and Japan). Regulation of retail pharmacy further constrains competition in France, Germany, and Italy. Regulation thus undermines the potential for significant savings on off-patent drugs, which account for a large and growing share of drug expenditures. Evidence of competition between therapeutic substitutes is less conclusive owing to data limitations.

Although theories in both evolutionary biology and economics predict that an individual's health should be associated with the individual's time preference, no prior study has been done to empirically support or refute such predictions. By collecting detailed measures of health, time preference, and expected longevity on a sample of individuals in townships around Durban, South Africa, this study breaks new ground by being the first to analyze in detail the relationship between time preference and health, in an area of the world with high mortality and morbidity. Interestingly, we find that both physical health and expectations of longevity have a U-shaped relationship with the person's subjective discount rate. This suggests that those in very poor health have high discount rates, but those in very good health also have high discount rates. Similarly those with longevity expectations on the extremes have high discount rates. The research question addressed by this pilot project is policy relevant, as the study tries to determine the importance of health in economic development, not from the commonly asserted productivity-gain argument, but from a much broader investment-for-thefuture argument.

The purpose of this study was to investigate family planning needs, knowledge of HIV transmission and HIV disclosure in a cohort sample that had undergone PMTCT in a resource poor setting. Five public clinics implementing PMTCT from Qaukeni Local Service Area, O.R. Tambo District in the Eastern Cape. The sample at postnatal care consisted of 758 women with known HIV status. From 116 HIV positive women 76.3% and from 642 HIV negative women 85.2% got counseling on safe sex during pregnancy but only 65.8% and 62.3% of the women respectively practiced safe sex during pregnancy, which did not differ by HIV status. Postnatally, almost all women received counseling on family planning, yet use of contraceptives and condoms were low. Among HIV positive women PMTCT knowledge and younger age of the mother were associated with pregnancy desire, and among HIV negative women HIV disclosure to the partner, younger age of the mother and having a lower number of children were associated with pregnancy desire. High pregnancy desires (yet lower than for HIV negative women); low contraceptive and condom use were found among HIV positive women. HIV prevention and family planning must acknowledge the reproductive desires of HIV positive women and men.