Sara Lowes, Eduardo Montero, 13 May 2018

Delivery of health aid can be jeopardised by distrust at the local level. This column uses evidence from French military campaigns in Cameroon and former French Equatorial Africa to show that a significant reason for this distrust may be aid recipients’ historical experiences of colonial medical campaigns. Building and maintaining trust in medicine should remain a priority for modern health interventions.

Charles Manski, 27 October 2017

In medical treatment, it is assumed that adherence to clinical practice guidelines is always preferable to decentralised clinical decision-making, yet there is no welfare analysis that supports this belief. This column argues that it would be better to treat clinical judgement as a problem of decision-making under uncertainty. In this case there would be no optimal way to make decisions, but there are reasonable ways with well-understood welfare properties.

Margaret Kyle, Heidi Williams, 22 May 2017

Despite higher per capita healthcare spending, US health outcomes compare poorly with other developed nations. One potential reason is that the US healthcare system creates incentives that promote the faster adoption of medical technologies with minimal benefits. This column tests this claim using data on the quality and diffusion of new pharmaceuticals in the US and four other countries. The results suggest that compared to Australia, Canada, Switzerland, and the UK, low-quality drugs diffuse more quickly in the US relative to high-quality drugs.

Alberto Galasso, Hong Luo, 24 July 2016

‘Defensive medicine’ refers to doctors performing excessive tests and procedures because of concerns about potential malpractice liability. Advocates for reform of the liability system typically argue that this raises healthcare costs with few expected benefits for patients. This column explores how tort reform laws designed to curb defensive medicine affect innovation in medical devices. US states that introduce such laws see a reduction in medical device patenting, suggesting that high liabilities actually encourage innovation.

Resul Cesur, Pınar Güneş, Erdal Tekin, Aydogan Ulker, 18 January 2016

The goal of universal health coverage has been pursued by countries in a number of ways, most notably through demand-side policies. In 2005, Turkey extended basic healthcare services to its entire population under a free-of-charge, centrally administered system. This column examines the impact of this supply-side programme on mortality and birth rates. Results show that the program was successful in lowering both mortality and birth rates across provinces, particularly for the most vulnerable populations. These findings provide compelling evidence in favour of providing accessible healthcare services to all citizens.

Rena Conti, Ernst Berndt, David Howard, 25 March 2015

Total US prescription drug spending rose 13% in 2014, the biggest increase in a decade. Driving this trend is spending on branded specialty drugs, which rose an unprecedented 31%. This column discusses recent research into the relationship between inflation-adjusted launch prices and survival benefits and approval year for 58 anticancer drugs approved in the US between 1995 and 2013. The authors find that launch prices are going up by $8,500 per year, approximately 12% year over year.

Amir Attaran, Roger Bate, Ginger Jin, Aparna Mathur, 08 October 2014

There is a perception amongst pharmaceutical experts that some Indian manufacturers and/or their distributors segment the global medicine market into portions that are served by different quality medicines. This column finds that drug quality is poorer among Indian-labelled drugs purchased inside African countries than among those purchased inside India or middle-income countries. Substandard drugs – non-registered in Africa and containing insufficient amounts of the active ingredient – are the biggest driver of this quality difference.

Charles Manski, 01 October 2014

Clinical practice guidelines recommend treating all patients with similar attributes the same way. This column argues that, under conditions of uncertainty or ambiguity, this may be bad advice. Treating similar patients differently provides two benefits. The first is diversification – assigning similar patients to different treatments limits the consequences of choosing an inappropriate treatment. The second benefit is that randomly assigning treatments helps clinicians learn which ones are most effective.

Daniel Bennett, Wes Yin, 14 August 2014

Many drugs sold in poor countries are counterfeit or substandard, endangering patients’ health and fostering drug resistance. Since drug quality is difficult to observe, pharmacies in weakly regulated markets may have little incentive to improve quality. However, larger markets allow firms to reorganise production and invest in technologies that reduce the marginal cost of quality. This column discusses how the entry of a new pharmacy chain in India led incumbents to both cut prices and raise drug quality.

Joan Costa-i-Font, Alistair McGuire, Nebibe Varol, 10 May 2014

Generic medicines are cheaper than their branded counterparts, offering potential savings in healthcare budgets. Medicine-price regulation plays an important role in the expansion of the market for generic medicines. This column presents new evidence that higher levels of price regulation, by lowering the expected price to generic manufacturers, lead (ceteris paribus) to greater delays in generic entry.

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