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  • 1. Bergman, Mats A.
    et al.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Rudholm, Niklas
    Squeezing the last drop out of your suppliers: an empirical study of market-based purchasing policies for generic pharmaceuticals2017In: Oxford Bulletin of Economics and Statistics, ISSN 0305-9049, E-ISSN 1468-0084, Vol. 79, no 6, p. 28p. 969-996Article in journal (Refereed)
    Abstract [en]

    We study the effect of the degree of exclusivity for the lowest bidder on the averageprice of generic pharmaceuticals in the short and long terms. Our results indicate that a1-percentage-point gain in market share of the lowest bidder reduces average costs by 0.2%in the short term and 0.8% in the long term, but also reduces the number of firms by 1%.We find that reducing the number of firms has a strong positive (and hence counteracting)effect on average prices, a 1% reduction raising prices by approximately 1%.

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  • 2.
    Bergman, Mats
    et al.
    Södertörns högskola, Sverige.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Fler konkurrenter är nyckeln för att sänka läkemedelspriserna2017In: Ekonomisk Debatt, ISSN 0345-2646, Vol. 45, no 7, p. 18-29Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Vi finner att fler konkurrenter på marknader för receptbelagda läkemedel varspatent löpt ut leder till lägre priser. Resultatet är väntat, men att empirisktkvantifiera effekten av ökad konkurrens på priset har visat sig vara förhållandevisbesvärligt. Orsaken till detta är problem såsom omvänd kausalitet ochicke-observerade kvalitetsskillnader, men på de marknader vi studerar är dessaproblem små. Resultaten visar att effekten av ytterligare konkurrenter är storäven när det befintliga antalet är betydande. Exempelvis medför en ökning frånsju till tio företag på lång sikt 21 procent lägre priser på generiska kopior.

  • 3. Bergman, Mats
    et al.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Department of Economics.
    Rudholm, Niklas
    Reforming the Swedish pharmaceuticals market: consequences for costs per defined daily dose2016In: International Journal of Health Economics and Management, ISSN 2199-9023, E-ISSN 2199-9031, Vol. 16, no 3, p. 201-214Article in journal (Refereed)
    Abstract [en]

    In 2009 and 2010, the Swedish pharmaceuticals market was reformed. One of the stated policy goals was to achieve low costs for pharmaceutical products dispensed in Sweden. We use price and sales data for off-patent brand-name and generic pharmaceuticals to estimate a log-linear regression model, allowing us to assess how the policy changes affected the cost per defined daily dose. The estimated effect is an 18 % cost reduction per defined daily dose at the retail level and a 34 % reduction in the prices at the wholesale level (pharmacies’ purchase prices). The empirical results suggest that the cost reductions were caused by the introduction of a price cap, an obligation to dispense the lowest-cost generic substitute available in the whole Swedish market, and the introduction of well-defined exchange groups. The reforms thus reduced the cost per defined daily dose for consumers while being advantageous also for the pharmacies, who saw their retail margins increase. However, pharmaceutical firms supplying off-patent pharmaceuticals experienced a clear reduction in the price received for their products.

  • 4.
    Bergman, Mats
    et al.
    Södertörns högskola, Huddinge, Sweden; HUI Research, Stockholm, Sweden.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Rudholm, Niklas
    Dalarna University, Sweden; HUI Resarch, Stockholm, Sweden.
    Reforming the Swedish pharmaceuticals market: Consequences for costs per defineddaily dose2014Report (Other academic)
    Abstract [en]

    In 2009, the Swedish pharmaceuticals market was reformed. One of the stated policygoals was to achieve low costs for pharmaceutical products dispensed in Sweden.

    Prices and sales data for off-patent brand-name and generic pharmaceuticals have beencollected, and a log-linear regression model was used to estimate how the policy changes affected thecost per defined daily dose.

    The estimated effect is a 19 percent cost reduction per defined daily dose at the retail leveland a 35 percent reduction in the prices at the wholesale level (pharmacies' purchase prices). Theempirical results suggest that half of the retail-level price reduction is due to the introduction of a pricecap for products going off patent and half is due to other components of the reform. Measured at thewholesale level the latter effect is larger than the former.

    The reforms reduced the cost per defined daily dose for consumers while beingadvantageous also for the pharmacies, who saw their retail margins increase due to the reform.However, pharmaceutical firms supplying off-patent pharmaceuticals experienced a clear reduction inthe price received for their products.

  • 5.
    Ching, Andrew T.
    et al.
    Carey Business School, Johns Hopkins University, MD, Baltimore, United States.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE).
    Sundström, David
    Department for Development of Processes and Methods, Statistics Sweden, Solna strandväg 86, Solna, Sweden.
    Quantifying the Zero-Price Effect in the Field: Evidence from Swedish Prescription Drug Choices2022In: Journal of the association for consumer research, ISSN 2378-1815, E-ISSN 2378-1823, Vol. 7, no 2, p. 175-185Article in journal (Refereed)
    Abstract [en]

    We use Swedish data on consumer choices of therapeutically equivalent drugs to measure the zero-price effect. The Swedish benefit scheme for prescription drugs is a tier system, where each patient’s copay share is a step function of his/her qualified accumulated expenditure and can ultimately drop to zero. The copay tier a patient falls into is exogenously determined by his/her health and drug needs. In any given month, a patient pays the copay share of the lowest priced drug, plus the price difference between the chosen drug and the lowest priced drug in the same therapeutically equivalent exchange group. Therefore, when consumers cross the threshold of the zero-copay tier, the net price for the lowest priced drug will switch from a small positive amount to zero. This unique quasi-random environment allows us to apply the regression discontinuity design to quantify the zero-price effect. We do so for the full sample, as well as for two subsamples that should be less affected by state dependence. Based on a linear (quadratic) specification, the estimated zero-price effect reduces choice shares of the noncheapest alternatives by 12% (13%), 39% (48%), and 23% (25%) in the full sample, new diagnoses sample, and switchers sample, respectively.

  • 6.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    A New Approach to Estimating State Dependence in Consumers’ Brand Choices Applied to 762 Pharmaceutical Markets*2021In: Journal of Industrial Economics, ISSN 0022-1821, E-ISSN 1467-6451, Vol. 69, no 2, p. 443-483Article in journal (Refereed)
    Abstract [en]

    This article shows how state dependence effects can be estimated for many markets and with few assumptions by using data on how the shares of consumers buying specific products differ between those who bought the same product on their latest purchase occasion and those who did not. Using information regarding which product was cheapest when consumers made their last purchases as instrument, I estimate that state dependence increases the probability that consumers will buy the product they bought the last time by eight percentage points. This effect is larger for women and the elderly than for men and younger consumers.

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  • 7.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Apotekens inköpspriser påverkas knappt av deras möjlighet att förhandla till sig rabatter2021In: Ekonomisk Debatt, ISSN 0345-2646, Vol. 49, no 1, p. 55-65Article in journal (Other academic)
    Abstract [sv]

    När apoteksmarknaden omreglerades fick läkemedelsbolag en möjlighet att ge apoteken rabatter på patentskyddade läkemedel. Regeringen hoppades att detta skulle stärka apotekens lönsamhet utan att medföra merkostnader för konsumenter och läkemedelsförmånen (prop. 2008/09:145). Jag beräknar att parallellimport före omregleringen gav besparingar på drygt 500 miljoner kronor per år i form av lägre listpriser. Detta är ungefär lika med Tandvårds- och läkemedelsförmånsverkets (TLV) uppskattning av de rabatter apoteken i genomsnitt fått per år efter omregleringen. Efter omregleringen leder dock inte parallellimport till signifikant lägre listpriser. Sammantaget verkar därmed omregleringen haft små effekter på apotekens faktiska inköpspriser för patentskyddade läkemedel. 

  • 8.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Direct and indirect savings from parallel imports in Sweden2022In: Health Economics Review, E-ISSN 2191-1991, Vol. 12, no 1, article id 46Article in journal (Refereed)
    Abstract [en]

    Background: The aim was: i) to quantify the direct and indirect savings from parallel imports in Sweden during a period when sellers were forbidden from giving discounts to pharmacies, and ii) to study if the effects of competition from parallel imports on list prices became smaller in absolute size when sellers were allowed to give discounts to pharmacies.

    Methods: We analyzed the monthly prices for 3068 products during 61 months when discounts were forbidden and for 2504 products during 84 months when discounts were allowed. The price effects were estimated using dynamic models that rendered lagged numbers of competitors into valid and strong instruments for the current values.

    Results: When discounts were forbidden, parallel imports had a market share of 16% and were on average 9% cheaper than locally sourced drugs, which yielded a direct saving of 231 million Swedish kronor (SEK) (24 million EUR) per year. Also, parallel imports reduced the prices of products with the same substance by, on average, 6% in the long-term, which yielded indirect savings of 421 million SEK (44 million EUR) per year. In total, parallel imports reduced the cost for on-patent pharmaceuticals by 4%. When discounts were allowed, the average gap in list price between parallel imports and locally sourced products was reduced to 0.8%, and the list prices of locally sourced products were no longer significantly affected by competition from parallel imports.

    Conclusion: When discounts were allowed, the savings of parallel imports through lower list prices were replaced by savings of pharmacies through secret discounts.

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  • 9. Granlund, David
    En allt rikare befolkning kräver mer resurser till hälso- och sjukvård2018In: Ekonomisk Debatt, ISSN 0345-2646, no 3, p. 3-4Article in journal (Other (popular science, discussion, etc.))
  • 10.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Medicin kostar mindre efter apoteksreformerna2017In: Ekonomisk Debatt, ISSN 0345-2646, Vol. 45, no 2Article in journal (Other (popular science, discussion, etc.))
  • 11.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    The Effect of Pharmacies' Right to Negotiate Discounts on the Market Share of Parallel Imported Pharmaceuticals2015In: The B.E. Journals in Economic Analysis & Policy, ISSN 2194-6108, E-ISSN 1935-1682, Vol. 15, no 3, p. 1197-1235Article in journal (Refereed)
    Abstract [en]

    This paper analyzes how allowing pharmacies to negotiate discounts with parallel traders and producers affects the market share for parallel imports. Economic theory predicts that discount negotiations will promote products bought directly from the producers because producers have cost advantages, due to which they always underbid the marginal prices of parallel traders. A reform that allowed discount negotiations is found to reduce the market share for parallel imports by about 11 percentage points to reach 31%. The results clearly indicate that pharmacies have an important role in the choice between medically equivalent pharmaceuticals.

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  • 12.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    The Price Effects of Competition from Parallel Imports and Therapeutic Alternatives: Using Dynamic Models to Estimate the Causal Effect on the Extensive and Intensive Margins2022In: Review of Industrial Organization, ISSN 0889-938X, E-ISSN 1573-7160, Vol. 60, p. 63-92Article in journal (Refereed)
    Abstract [en]

    This paper studies responses to competition with the use of dynamic models that distinguish between short- and long-term price effects. The dynamic models also allow lagged numbers of competitors to become valid and strong instruments for the current numbers, which enables studying the causal effects using flexible specifications. A first parallel trader is found to decrease prices of exchangeable products by 7% in the long term. On the other hand, prices do not respond to the first competitor that sells therapeutic alternatives; but competition from four or more competitors that sell on-patent therapeutic alternatives decreases prices by about 10% in the long term.

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  • 13.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Bergman, Mats
    Price competition in pharmaceuticals – evidence from 1303 Swedish markets2017Conference paper (Other academic)
    Abstract [en]

    We study the short- and long-term price effects of the number of competing firms, using panel-data on 1303 distinct pharmaceutical markets for 78 months. We use actual transaction prices in an institutional setting with little room for non-price competition and where simultaneity problem can be addressed effectively. In the long term, the price of generics is found to decrease by 81% when the number of firms selling generics with the same strength, form and similar package sizes is increased from 1 to 10. It is nearly only competition on this fine-grained level that matters. For example, the price effect of firms selling other products with the same active substance, but with different package size, form, or strength, is only a tenth as large. Half of the price reductions take place immediately and 70% within three months. Also, prices of originals are found to react to competition, but far less and much slower; going from 1 to 10 firms selling nearly identical generics reduces prices by 29% in the long term but by only 2% in the short term.

  • 14.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Bergman, Mats
    Price competition in pharmaceuticals: evidence from 1303 Swedish markets2018In: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 61, p. 1-12Article in journal (Refereed)
    Abstract [en]

    We study the short- and long-term price effects of the number of competing firms, using panel-data on 1303 distinct pharmaceutical markets for 78 months within a reference-price system. We use actual transaction prices in an institutional setting with little scope for non-price competition and where simultaneity problems can be addressed effectively. In the long term, the price of generics is found to decrease by 81% when the number of firms selling generics with the same strength, form and similar package size is increased from 1 to 10. Nearly only competition at this fine-grained level matters; the effect of firms selling other products with the same active substance, but with different package size, form, or strength, is only a tenths as large. Half of the price reductions take place immediately and 70% within three months. Also, prices of originals are found to react to competition, but far less and much slower.

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  • 15.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Bergman, Mats
    Södertörn University, Sweden.
    Price competition in pharmaceuticals: evidence from 1303 Swedish markets2017Report (Other academic)
    Abstract [en]

    We study the short- and long-term price effects of number of competing firms using panel-data on 1303 distinct pharmaceutical markets for 78 months. This is done using actual transaction prices in an institutional setting with little room for non-price competition and where simultaneity problem can be addressed effectively. In the long-term, the price of generics is found to decrease by 81% when the number of firms selling generics is increased from 1 to 10. Half of this reduction takes place immediately and 70% within three months. Also, prices of originals are found to react to competition, but far less and much slower; going from 1 to 10 firms reduces their price by 29% in the long term but by only 2% in the short term.

  • 16.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Indén, Tobias
    Umeå University, Faculty of Social Sciences, Department of Law.
    Lundberg, Johan
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Lundberg, Sofia
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Wikström, Magnus
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Det offentliga som konkurrent på kommersiella marknader - En samhällsekonomisk analys med exemplet konferensmarknaden2017Report (Other academic)
    Abstract [sv]

    I den här rapporten analyseras samhällsekonomiska effekter av att det offentliga konkurrerar med privata företag på kommersiella marknader. Den innehåller även en pilotstudie av marknaden för en – och tvådagarskonferenser tillämpad på Umeåregionen.

    Svensk konkurrenslagstiftning inkluderar regler om konkurrensbegränsande offentlig säljverksamhet. Reglerna gäller för den offentliga sektorn i sin helhet, dvs stat, primärkommuner (kommun) eller landstingskommuner (landsting) och juridiska personer vars verksamhet den offentliga sektorn har ett dominerande inflytande över. Inflytandet kan ta sig formen av ägande, finansieringsvillkor, styrelse, lag och avtal. Frågan om det offentliga som konkurrent är även samhällsekonomiskt relevant då snedvridning av konkurrens i form av exempelvis underprissättning till följd av stöd, kan innebära en samhällsekonomisk förlust.

    Sammantaget visar den samhällsekonomiska analysen att det inte går att dra några generella slutsatser om att konkurrens från den offentliga sektorn på marknader med en etablerad kommersiell verksamhet alltid är problematisk. Även i situationer där konkurrensen sker på olika villkor kan fördelarna med den offentliga aktörens medverkan överväga nackdelarna. Baserat på pilotstudien och olika scenarios avseende  konferensmarknaden i Umeå, är det möjligt att dra slutsatsen att fördelarna med offentliga aktörer kan dominera nackdelarna under förutsättning att den offentliga aktörens produktionskostnad maximalt är en procent högre än en privat aktörs produktionskostnad för motsvarande konferens. Analysen visar att subventioner till offentliga aktörer överskridande 1,3 miljoner kronor inte kan motiveras utifrån ett samhällsekonomiskt perspektiv i något scenario. I scenariot där den offentliga aktören ägnar sig åt underprissättning överväger nackdelarna även om verksamheten klarar sig utan subvention.

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  • 17.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Köksal-Ayhan, Miyase Yesim
    EU Enlargement, Parallel Trade and Price Competition in Pharmaceuticals: has the Price Competition increased?2016In: The B.E. Journals in Economic Analysis & Policy, ISSN 2194-6108, E-ISSN 1935-1682, Vol. 16, no 2, p. 1069-1092Article in journal (Other academic)
    Abstract [en]

    Given the cost of trade and availability of pharmaceuticals, the driving force for parallel trade is the price difference between the source (exporting) and the destination (importing) country. An increase in the price difference or in the availability of pharmaceuticals for parallel trade should increase price competition in the destination country. Using 2003-2007 data from Sweden we investigated whether EU enlargement in 2004, when new countries with low pharmaceutical prices joined the EU, increased competition from parallel imports. Drugs facing competition from parallel imports are found to have on average 17% to 21% lower prices than they would have had if they had never faced such competition. But, contrary to expectation, EU enlargement is not found to have increased this effect, which might be explained by derogations and changes in consumer perceptions of parallel imports.

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  • 18.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Environmental and Resource Economics (CERE). Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Meens-Eriksson, Sef
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics. Umeå University, Faculty of Social Sciences, Centre for Environmental and Resource Economics (CERE).
    Companies price discriminate based on sellers’ relative transport costs to competitorsManuscript (preprint) (Other academic)
  • 19.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Rudholm, Niklas
    Risker och kostnader för prissamordningar på den svenska generikamarknaden2018Report (Other academic)
    Abstract [sv]

    Företag som ofta möter varandra på en eller flera marknader kan ibland genom att observera varandras tidigare priser lyckas samordna sina priser. Konkurrensen sätts då ur spel och priserna blir högre än de annars skulle ha varit. I denna rapport visar vi att den svenska generikamarknaden har många egenskaper som underlättar prissamordning, exempelvis att priserna kan ändras varje månad, att företagen lätt kan observera varandras priser, och att konkurrensen främst sker i en variabel, priser. Vi redogör även för empiriska resultat som indikerar att prissamordningar ibland förekommer på marknaden, samt att dessa då orsakar läkemedelsförmånen och konsumenterna betydande merkostnader. Dessa uppskatter vi till i storleksordningen 50 till 200 miljoner kronor per år.

    Ett sätt att minska risken för prissamordning är att förlänga tiden mellan att företag kan observera konkurrenters priser och att de kan ändra sina egna priser. Det är sedan länge välkänt inom nationalekonomin att denna tid har en avgörande betydelse för risken för prissamordning. Tiden kan förlängas genom att priserna endast tillåts ändras exempelvis kvartalsvis eller halvårsvis och/eller genom att kräva att företagen meddelar sina priser längre tid i förväg innan prisperioderna börjar. En förlängning av prisperioderna till 3-6 månader skulle troligen ha mycket små oönskade effekter samtidigt som det skulle minska möjligheterna för företag att samordna sina priser. Sammantaget skulle därför en sådan förändring troligen minska läkemedelsförmånens och konsumenternas kostnader.

    Ett annat sätt att minska risken för att företag samordnar sina priser är att sänka marknadsandelen för periodens vara genom att minska kraven att de förskrivna varorna byts ut på apoteken. Detta skulle öka betydelsen av andra faktorer än priset och göra det svårare för företag att över tid dela försäljningen lika, vilket minskar risken för prissamordning. En tidigare studie visar också att detta skulle leda till fler konkurrerande företag på marknaden, vilket även det minskar risken för att företag samordnar sina priser. En lägre marknadsandel för periodens vara skulle dock kunna leda till svagare konkurrens och ökade kostnader för läkemedel på marknader som inte påverkas av prissamordningar. För hela generikamarknaden skulle en liten sänkning av marknadsandelen för periodens vara kunna bli kostnadsneutral, men det är inte säkert att detta resultat håller om prisperioderna förlängs.

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  • 20.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Sundström, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Physicians prescribing originals causes welfare losses2018In: Economics Letters, ISSN 0165-1765, E-ISSN 1873-7374, Vol. 170, p. 143-146Article in journal (Refereed)
    Abstract [en]

    We analyze 319,000 choices of medically equivalent drugs at Swedish pharmacies. The results show that patients dislike substitutions for the prescribed product and that this effect is larger when the prescribed product is an original. At the same time, patients have strong preferences to buy the cheapest generic product. This implies that patients in most cases buy the cheapest generic product and experience welfare losses when the physician has prescribed another product.

  • 21.
    Granlund, David
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Zykova, Yana V.
    Can Private Provision of Primary Care Contribute to the Spread of Antibiotic Resistance?: A Study of Antibiotic Prescription in Sweden2021In: PharmacoEconomics - Open, ISSN 2509-4262, Vol. 5, no 2, p. 187-195Article in journal (Refereed)
    Abstract [en]

    Background: Growing rates of antibiotic resistance, caused by increasing antibiotic use, pose a threat by making antibiotics less effective in treating infections.

    Objective: We aimed to study whether physicians working at privately and publicly owned health centres differed in the likelihood of prescribing antibiotics and choosing broad-spectrum over narrow-spectrum antibiotics.

    Methods: To estimate the effect of ownership on the probability of a prescribed drug being an antibiotic, we analysed all 4.5 million prescriptions issued from 2011 to 2015 at primary health centres in Västerbotten, Sweden. We controlled for patient age, sex, number of prescriptions per patient, and month of prescription, and used a maximum likelihood logit estimator. We then analysed how ownership affected the likelihood of a prescribed antibiotic being broad spectrum. We also used aggregated data to estimate the impact of the number of private health centres on the number of antibiotic prescriptions per inhabitant and the proportion of broad-spectrum antibiotics.

    Results: Holding other factors constant, private physicians were 6% more likely to prescribe antibiotics and 9% more likely to choose broad-spectrum antibiotics. An increase by one additional private health centre was positively associated with an increase in the number of antibiotic prescriptions per inhabitant and a higher proportion, although not significant, of broad-spectrum antibiotic prescriptions.

    Conclusion: Our findings suggest that private physicians prescribe more antibiotics, especially broad-spectrum antibiotics, than public physicians. Therefore, it is crucial to provide health centres with incentives to follow guidelines for antibiotic prescription, especially when the level of private provision of primary healthcare is high.

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  • 22.
    Janssen, Aljoscha
    et al.
    Singapore Management University, Department of Economics, 90 Stamford Rd, Singapore.
    Granlund, David
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    The importance of the first generic substitution: Evidence from Sweden2023In: Journal of Economic Behavior and Organization, ISSN 0167-2681, E-ISSN 1879-1751, Vol. 213, p. 1-25Article in journal (Refereed)
    Abstract [en]

    We analyze changes in the willingness to substitute from prescribed pharmaceuticals to more affordable generic equivalents in response to the first experience with a substitution. Using Swedish individual-level data of prescribed and dispensed pharmaceuticals, we employ a dynamic event study and an instrumental variable approach to show that an initial substitution reduces the probability of opposing subsequent substitutions by 39 percentage points. We recommend that policy-makers target patients with a history of opposed substitution and offer additional discounts to promote substitution as long-term savings outweigh one-time costs.

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