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Executive summaryThis paper studies the effects of a reference price reform in Denmark on price and demand for statins, products that reduce the blood cholesterol levels. Too high cholesterol levels may cause cardiovascular diseases. Reference pricing is a cost containment tool that is applied to reduce health expenditures in 19 European countries as well as Australia, British Columbia and New Zealand.Our paper is the first to combine price data and demand data to study reform effects. We produce estimates for changes in total government (health care) expenditures, patient expenditures, patient welfare and producer revenues.A main finding is that government and patients did indeed benefit in terms of price declines and declining total expenditures from the reform while producers incurred losses.There are, however, striking differences between products that were "cheap" before the reform and those that were "expensive" before the change. The benefits to patients and the government were primarily due to the initially expensive products. The reform effects were hence quite asymmetrically distributed across products (and thus patients).We also show that an empirical analysis of the reform effects that studies price changes only may lead to quite misleading implications for welfare analysis. On April 1, 2005, Denmark changed the way references prices, a main determinant of reimbursements for pharmaceutical purchases, are calculated. The previous reference prices, which were based on average EU prices, were substituted to minimum domestic prices. Novel to the literature, we estimate the joint effects of this reform on prices and quantities. Prices decreased more than 26 percent due to the reform, which reduced patient and government expenditures by 3.0 percent and 5.6 percent, respectively, and producer revenues by 5.0 percent. The prices of expensive products decreased more than their cheaper counterparts, resulting in large differences in patient benefits from the reform.
Das Wichtigste in Kürze
JEL-classification: I18, C23