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  • 1. Andrén, Daniela
    et al.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi. HUI Research, Sweden.
    Introducing waiting times for health care in a labor supply model for sickness absence2015Ingår i: Nordic Journal of Health Economics, ISSN 1892-9729, E-ISSN 1892-9710, Vol. 3, nr 1, s. 34-46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper studies the association between waiting times for different health care services and the duration of sick leave, using a Swedish register database supplemented with information from questionnaires for 3,653 employees. The duration of sick leave is positively associated with waiting two weeks or more for primary care, technical investigations and specialists, compared to waiting one week or less. Except for waiting for a specialist, there is no indication that waiting four weeks or more is associated with longer durations of sick leave than waiting two to three weeks. Long waiting times for surgery is negatively associated with the duration of sick leave, which might be explained by prioritizing where patients with longer waiting times are those with less severe conditions. Including these waiting time variables did not induce substantial changes on the impact of traditional labor supply variables, which suggests that the parameter estimates of traditional variables are relatively robust.

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  • 2.
    Andrén, Daniela
    et al.
    Handelshögskolan vid Örebro universitet.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    "Waiting for the other shoe to drop": waiting for health care and duration of the sickness leave2010Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This paper uses a labor supply model that incorporates waiting for health care to derive an empirical specification for sick leave and to estimate the impact of waiting for health care on the duration of sick leave. In the estimations, we use the 2002 sample of the RFV-LS register database, supplemented with information from questionnaires. The results indicate that almost all waiting for health care variables have a statistically significant positive impact on the duration of sick leave, and did not induce substantial changes on the impact of traditional variables of the labor supply model.

  • 3.
    Aronsson, Thomas
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Federal Governments Should Subsidize State Expenditure that Voters do not Consider when Voting2014Rapport (Övrigt vetenskapligt)
    Abstract [en]

    This short paper analyzes whether a federal transfer system can be designed to increase welfare, when state governments create political budget cycles to increase the likelihood of reelection. The results show how the federal government may announce a transfer scheme in advance for the post-election year that counteracts the welfare costs of political budget cycles.

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  • 4.
    Aronsson, Thomas
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Federal subsidization of state expenditure to reduce political budget cycles2017Ingår i: International Tax and Public Finance, ISSN 0927-5940, E-ISSN 1573-6970, Vol. 24, nr 3, s. 536-545Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this note, we analyze whether a federal transfer system can be designed to increase welfare when state governments create political budget cycles. The results show how the federal government can counteract the welfare costs of these cycles, without hindering politicians from signaling their type, by announcing a transfer scheme to subsidize expenditures that voters do not consider when voting.

  • 5.
    Aronsson, Thomas
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Gender Norms, Work Hours, and Corrective Taxation2013Rapport (Övrigt vetenskapligt)
    Ladda ner fulltext (pdf)
    Gender Norms, Work Hours, and Corrective Taxation
  • 6.
    Aronsson, Thomas
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Gender Norms, Work Hours, and Corrective Taxation2015Ingår i: Journal of Behavioral and Experimental Economics, ISSN 2214-8043, E-ISSN 2214-8051, Vol. 56, s. 33-39Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper deals with optimal income taxation based on a household model, where men and women allocate their time between market work and household production, and where households differ depending on which spouse has the comparative advantage in market work. The purpose is to analyze the tax policy implications of gender norms represented by a market work norm for men and household work norm for women. We show how the optimal (corrective) tax policy depends on the definition of social norms, the preferences for obeying these norms, and whether men or women have the comparative advantage in market work. Two extreme results are that (i) corrective taxation should not be used at all if the norms are based on the mean value of market work and household work, respectively, given that all households have the same preferences, and (ii) only the majority household type should be taxed at the margin if the norms are instead based on the modal value.

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  • 7.
    Aronsson, Thomas
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Present-Biased Preferences and Publicly Provided Private Goods2014Ingår i: Finanzarchiv, ISSN 0015-2218, E-ISSN 1614-0974, Vol. 70, nr 2, s. 169-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper analyzes the welfare effects of a publicly provided private good with long-term consequences for individual well-being, in an economy where consumers have present-biased preferences due to quasihyperbolic discounting. The analysis is based on a two-type model with asymmetric information between the government and the private sector, and each consumer fives for three periods. We present formal conditions under which public provision to the young and the middle-aged generation, respectively, leads to higher welfare. Our results show that quasihyperbolic discounting provides a strong incentive for public provision to the young generation - especially if the consumers are naive (as opposed to sophisticated).

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  • 8.
    Aronsson, Thomas
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Public goods and optimal paternalism under present-biased preferences2011Ingår i: Economics Letters, ISSN 0165-1765, E-ISSN 1873-7374, Vol. 113, nr 1, s. 54-57Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper concerns the provision of a state-variable public good in a two-type model under present-biased consumer preferences. The preference for immediate gratification facing the high-ability type weakens the incentive to adjust public provision in response to the self-selection constraint.

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    Public goods and optimal paternalism under present-biased preferences
  • 9. Bergman, Mats A.
    et al.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Rudholm, Niklas
    Squeezing the last drop out of your suppliers: an empirical study of market-based purchasing policies for generic pharmaceuticals2017Ingår i: Oxford Bulletin of Economics and Statistics, ISSN 0305-9049, E-ISSN 1468-0084, Vol. 79, nr 6, s. 28s. 969-996Artikel i tidskrift (Refereegranskat)
    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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  • 10.
    Bergman, Mats
    et al.
    Södertörns högskola, Sverige.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Fler konkurrenter är nyckeln för att sänka läkemedelspriserna2017Ingår i: Ekonomisk Debatt, ISSN 0345-2646, Vol. 45, nr 7, s. 18-29Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    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.

  • 11.
    Bergman, Mats
    et al.
    HUI Research och Södertörns högskola, Sverige.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi. HUI Research.
    Rudholm, Niklas
    HUI Research och Högskolan Dalarna, Sverige.
    Apoteksmarknadens omreglering: effekter på följsamhet, priser och kostnader per dygnsdos2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Denna rapport ingår som en del i Tillväxtanalys projekt att utvärdera effekterna av omregleringen av apoteksmarknaden, särskilt vad gäller priserna. Uppdraget är en uppföljning och utvidgning av Tillväxtanalys WP/PM 2011:50 författat av Bergman och Rudholm. Syftet är att empiriskt studera hur omregleringen påverkat apotekens följsamhet, andel av försäljningen som avser billigaste generika, den så kallade månadens vara, priserna på receptbelagda läkemedel på generikamarknaden, samt vilken totalkostnadseffekt mätt som kostnaden per konsumerad dygnsdos reformen haft. Den senare aspekten är ny jämfört med den tidigare rapporten, medan övriga delar innebär en replikering.

    Resultaten visar entydigt att följsamheten ökat på grund av reformerna oavsett vilket följsamhetsmått vi använder. Resultaten vad gäller reformernas påverkan på leverantörernas prissättnings- och budstrategier är mera splittrade. Denna del av rapporten syftar till att förstå prissättningen på generikamarknaden och att analysera generikamarknadens funktionssätt, snarare än att analysera om apoteksmarknadsreformen totalt sett medfört en ökad eller minskad kostnad för generiska läkemedel.

    Resultaten från uppdragets tredje del, att estimera reformernas effekter på kostnaden per konsumerad dygnsdos visar att kostnaden sjunkit som en följd av omregleringen. Kostnadssänkningen uppskattas till ungefär 10 procent mätt i AUP och ungefär 30 procent mätt i AIP. Den större sänkningen mätt i AIP förklaras dels av marginalförstärkningen och av att en viss procentuell prissänkning i AIP ger en lägre procentuell sänkning av AUP på grund av de prisoberoende delarna i apotekens marginaler.

  • 12. Bergman, Mats
    et al.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Rudholm, Niklas
    Reforming the Swedish pharmaceuticals market: consequences for costs per defined daily dose2016Ingår i: International Journal of Health Economics and Management, ISSN 2199-9023, E-ISSN 2199-9031, Vol. 16, nr 3, s. 201-214Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Bergman, Mats
    et al.
    Södertörns högskola, Huddinge, Sweden; HUI Research, Stockholm, Sweden.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Rudholm, Niklas
    Dalarna University, Sweden; HUI Resarch, Stockholm, Sweden.
    Reforming the Swedish pharmaceuticals market: Consequences for costs per defineddaily dose2014Rapport (Övrigt vetenskapligt)
    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.

  • 14.
    Ching, Andrew T.
    et al.
    Carey Business School, Johns Hopkins University, MD, Baltimore, United States.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet.
    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 Choices2022Ingår i: Journal of the association for consumer research, ISSN 2378-1815, E-ISSN 2378-1823, Vol. 7, nr 2, s. 175-185Artikel i tidskrift (Refereegranskat)
    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.

  • 15.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    A New Approach to Estimating State Dependence in Consumers’ Brand Choices Applied to 762 Pharmaceutical Markets*2021Ingår i: Journal of Industrial Economics, ISSN 0022-1821, E-ISSN 1467-6451, Vol. 69, nr 2, s. 443-483Artikel i tidskrift (Refereegranskat)
    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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  • 16.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Apotekens inköpspriser påverkas knappt av deras möjlighet att förhandla till sig rabatter2021Ingår i: Ekonomisk Debatt, ISSN 0345-2646, Vol. 49, nr 1, s. 55-65Artikel i tidskrift (Övrigt vetenskapligt)
    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. 

  • 17.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Are private physicians more likely to veto generic substitution of prescribed pharmaceuticals?2009Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 69, nr 11, s. 1643-1650Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Physicians' decisions whether or not to veto generic substitution were analyzed using a sample of 350,000 pharmaceutical prescriptions from the county of Västerbotten, Sweden. The primary purpose was to test if physicians working at private practices were more likely to oppose substitution than county-employed physicians working on salary. It was found that private physicians were 50-80% more likely to veto substitution. Also, the probability of a veto was found to be increased as patients' copayments decreased. This might indicate moral hazard in insurance, though other explanations are plausible.

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    Are private physicians more likely to veto generic substitution
  • 18.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Direct and indirect savings from parallel imports in Sweden2022Ingår i: Health Economics Review, E-ISSN 2191-1991, Vol. 12, nr 1, artikel-id 46Artikel i tidskrift (Refereegranskat)
    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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  • 19.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Economic policy in health care: Sickness absence and pharmaceutical costs2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This thesis consists of a summary and four papers. The first two concerns health care and sickness absence, and the last two pharmaceutical costs and prices.

    Paper [I] presents an economic federation model which resembles the situation in, for example, Sweden. In the model the state governments provide health care, the fed-eral government provides a sickness benefit and both levels tax labor income. The re-sults show that the states can have either an incentive to under- or over-provide health care. The federal government can, by introducing an intergovernmental transfer, in-duce the state governments to provide the socially optimal amount of health care.

    In Paper [II] the effect of aggregated public health care expenditure on absence from work due to sickness or disability was estimated. The analysis was based on data from a panel of the Swedish municipalities for the period 1993-2004. Public health care expenditure was found to have no statistically significant effect on absence and the standard errors were small enough to rule out all but a minimal effect. The result held when separate estimations were conducted for women and men, and for absence due to sickness and disability.

    The purpose of Paper [III] was to study the effects of the introduction of fixed pharmaceutical budgets for two health centers in Västerbotten, Sweden. Estimation results using propensity score matching methods show that there are no systematic differences for either price or quantity per prescription between health centers using fixed and open-ended budgets. The analysis was based on individual prescription data from the two health centers and a control group both before and after the introduction of fixed budgets.

    In Paper [IV] the introduction of the Swedish substitution reform in October 2002 was used as a natural experiment to examine the effects of increased consumer infor-mation on pharmaceutical prices. Using monthly data on individual pharmaceutical prices, the average reduction of prices due to the reform was estimated to four percent for both brand name and generic pharmaceuticals during the first four years after the reform. The results also show that the price adjustment was not instant.

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    FULLTEXT01
  • 20.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Electoral accountability in a two-tiered government country2011Ingår i: Public Choice, ISSN 0048-5829, E-ISSN 1573-7101, Vol. 148, nr 3-, s. 531-546Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In democracies, elections are the primary mechanism for making politicians act in voters’ interests, but voters are unable to prevent that some resources are diverted to political rents. With two levels of government, the rents are reduced if voters require higher beneficial public expenditures for reelecting incumbents. Voters can also strengthen their power by holding politicians liable also for decisions made by the other level of government. When the incumbent at one level acts as a Stackelberg leader with respect to the other, there is no risk of this leading to Leviathan policies on the part of the incumbents.

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    Electoral accountability
  • 21.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Generisk förskrivning av läkemedel: våga ta steget fullt ut2012Ingår i: Ekonomisk Debatt, ISSN 0345-2646, Vol. 40, nr 3, s. 3-4Artikel i tidskrift (Övrigt vetenskapligt)
  • 22.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Maximera välfärd, inte BNP2015Ingår i: Ekonomisk Debatt, ISSN 0345-2646, Vol. 3, s. 91-91Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
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  • 23.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Medicin kostar mindre efter apoteksreformerna2017Ingår i: Ekonomisk Debatt, ISSN 0345-2646, Vol. 45, nr 2Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 24.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Price and welfare effects of a pharmaceutical substitution reform2010Ingår i: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 29, nr 6, s. 856-865Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The price effects of the Swedish pharmaceutical substitution reform are analyzed using data for a panel of all pharmaceutical product sold in Sweden in 1997-2007. The price reduction due to the reform was estimated to average 10% and was found to be significantly larger for brand-name pharmaceuticals than for generics. The results also imply that the reform amplified the effect that generic entry has on brand-name prices by a factor of 10. Results of a demand estimation imply that the price reductions increased total pharmaceutical consumption by 8% and consumer welfare by SEK 2.7 billion annually.

    Ladda ner fulltext (pdf)
    Price and welfare effects of a pharmaceutical substitution reform
  • 25.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Sickness absence and health care in an economic federation2007Ingår i: International Tax and Public Finance, ISSN 0927-5940, E-ISSN 1573-6970, Vol. 14, nr 4, s. 503-524Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper addresses vertical fiscal externalities in a model where the state governments provide health care and the federal government provides a sickness benefit. Both levels of government tax labor income and policy decisions affect labor income as well as participation in the labor market. The results show that the vertical externality affecting the state governments' policy decisions can be either positive or negative depending on, among other things, the wage elasticity of labor supply and the marginal product of expenditure on health care. Moreover, it is proved that the vertical fiscal externality will not vanish by assigning all powers of taxation to the states.

    Ladda ner fulltext (pdf)
    Sickness absence and health care in an economic federation
  • 26.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Skattekilarna får inte blir för låga2015Ingår i: Ekonomisk Debatt, ISSN 0345-2646, nr 1, s. 3-4Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Ladda ner fulltext (pdf)
    fulltext
  • 27.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    The effect of health care expenditure on sickness absence2010Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 11, nr 6, s. 555-568Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Increased health care expenditure could be used to improve quality of care or reduce waiting time and could therefore be expected to affect the health and sickness absence of a population. Still, based on data from a panel of Swedish municipalities, public health care expenditure was found to have no, or only a negligible effect on absence due to sickness or disability. The same result was obtained when separate estimates were done for men and women and for absence due to sickness and disability.

    Ladda ner fulltext (pdf)
    The effect of health care expenditure on sickness absence
  • 28.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    The effect of pharmacies’ right to negotiate discounts on the market share of parallel imported pharmaceuticalsManuskript (preprint) (Övrigt vetenskapligt)
  • 29.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    The Effect of Pharmacies' Right to Negotiate Discounts on the Market Share of Parallel Imported Pharmaceuticals2015Ingår i: The B.E. Journals in Economic Analysis & Policy, ISSN 1935-1682, E-ISSN 1935-1682, Vol. 15, nr 3, s. 1197-1235Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 30.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    The Price Effects of Competition from Parallel Imports and Therapeutic Alternatives: Using Dynamic Models to Estimate the Causal Effect on the Extensive and Intensive Margins2022Ingår i: Review of Industrial Organization, ISSN 0889-938X, E-ISSN 1573-7160, Vol. 60, s. 63-92Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 31.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Utbyte av läkemedel har lett till prissänkningar2011Ingår i: Ekonomisk debatt, ISSN 0345-2646, Vol. 39, nr 6, s. 35-46Artikel i tidskrift (Övrigt vetenskapligt)
  • 32.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Bergman, Mats
    Price competition in pharmaceuticals – evidence from 1303 Swedish markets2017Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 33.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Bergman, Mats
    Price competition in pharmaceuticals: evidence from 1303 Swedish markets2018Ingår i: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 61, s. 1-12Artikel i tidskrift (Refereegranskat)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 34.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Bergman, Mats
    Södertörn University, Sweden.
    Price competition in pharmaceuticals: evidence from 1303 Swedish markets2017Rapport (Övrigt vetenskapligt)
    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.

  • 35.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Chuc, NT
    Faculty of Public Health, Hanoi Medical University, Viet Nam.
    Phuc, HD
    Institute of Mathematics, Hanoi, Viet Nam.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Inequality in mortality in Vietnam during a period of rapid transition2010Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 70, nr 2, s. 232-239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The associations between socioeconomic variables and mortality for 41,000 adults Vietnamese followed from January 1999 to March 2008 are estimated using Cox's proportionally hazard models. Also, we use decomposition techniques to investigate the relative importance of socioeconomic factors for explaining inequality in age-standardized mortality risk. The results confirm previously found negative association between mortality and income and education, for both men and women. We also found that marital status, at least for men, explain a large and growing part of the inequality. Finally, estimation results for relative education variables suggest that there exist positive spillover of education, meaning that that higher education of one's neighbors or spouse might reduce ones mortality risk.

    Ladda ner fulltext (pdf)
    Inequality in mortality in Vietnam during a period of rapid transition
  • 36.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Indén, Tobias
    Umeå universitet, Samhällsvetenskapliga fakulteten, Juridiska institutionen.
    Lundberg, Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Lundberg, Sofia
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Wikström, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Det offentliga som konkurrent på kommersiella marknader - En samhällsekonomisk analys med exemplet konferensmarknaden2017Rapport (Övrigt vetenskapligt)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 37.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi. HUI Research, SE-103 29, Stockholm, Sweden.
    Köksal, Miyase Yesim
    Parallel Imports and Mandatory Substitution Reform: a kick or a muff for price competition in pharmaceuticals?2015Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 16, nr 9, s. 969-983Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    What has been the effect of competition from parallel imports on prices of locally-sourced on-patent drugs? Did the 2002 Swedish mandatory substitution reform increase this competition? To answer these questions, we carried out difference-in-differences estimation on monthly data for a panel of all on-patent prescription drugs sold in Sweden during the 40 months from January 2001 through April 2004. On average, facing competition from parallel imports caused a 15-17% fall in price. While the reform increased the effect of competition from parallel imports, it was only by 0.9%. The reform, however, did increase the effect of therapeutic competition by 1.6%.

    Ladda ner fulltext (pdf)
    fulltext
  • 38.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Köksal-Ayhan, Miyase Yesim
    EU Enlargement, Parallel Trade and Price Competition in Pharmaceuticals: has the Price Competition increased?2016Ingår i: The B.E. Journals in Economic Analysis & Policy, ISSN 1935-1682, E-ISSN 1935-1682, Vol. 16, nr 2, s. 1069-1092Artikel i tidskrift (Övrigt vetenskapligt)
    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.

    Ladda ner fulltext (pdf)
    fulltext
  • 39.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för miljö- och naturresursekonomi (CERE). Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Meens-Eriksson, Sef
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi. Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för miljö- och naturresursekonomi (CERE).
    Companies price discriminate based on sellers’ relative transport costs to competitorsManuskript (preprint) (Övrigt vetenskapligt)
  • 40.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Rudholm, Niklas
    Handelns utredningsinstitut, Stockholm.
    Consumer information and pharmaceutical prices: theory and evidence2011Ingår i: Oxford Bulletin of Economics and Statistics, ISSN 0305-9049, E-ISSN 1468-0084, Vol. 73, nr 2, s. 230-254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this paper, the impact of increased consumer information on brand name and generic pharmaceutical prices is analyzed both theoretically and empirically. The theoretical results show that an increase in information is likely to reduce the price of brand name pharmaceuticals, while the results regarding generics are less clear. In the empirical part of the paper, the introduction of the substitution reform in the Swedish pharmaceuticals market in October 2002 is used as a natural experiment regarding the effects of increased consumer information on pharmaceutical prices. The results clearly show that the reform has lowered the price of both brand name- and generic pharmaceuticals

    Ladda ner fulltext (pdf)
    Consumer information and pharmaceutical prices
  • 41.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Rudholm, Niklas
    Handelns Utredningsinstitut, Stockholm .
    Consumer loyalty in the Swedish pharmaceutical market2008Rapport (Övrigt vetenskapligt)
    Abstract [en]

    The purpose of this paper is to test if consumer loyalty is strongertoward brand name pharmaceutical products and branded generics ascompared to "true" generics in the Swedish pharmaceuticals market. Theresults show that consumers are equally loyal toward brand name pharmaceuticalsand branded generics, while substantially less loyal towardgenerics. The results thus seem to give support to the idea that brandname recognition is important in creating consumer loyalty toward pharmaceuticalproducts.

  • 42.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Rudholm, Niklas
    Handelns utredningsinstitut, Stockholm, Sweden; Department of Economics, Dalarna University, Sweden.
    Does increased price competition reduce entry of new pharmaceutical products?2011Ingår i: Advances in Management and Applied Economics, ISSN 1792-7544, E-ISSN 1792-7552, Vol. 1, nr 1, s. 1-14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In October 2002, a substitution reform was introduced in the Swedish pharmaceuticals market. In this paper, the effects of increased price competition due to the reform on the entry of new pharmaceutical products were studied. The results show that the reform did affect the entry behavior of generic manufacturers as they became more prone to enter new package sizes into the market after the reform, but also that there is considerable heterogeneity in entry behavior between different ATC-code groups for both brand name and generic products.

  • 43.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Rudholm, Niklas
    Risker och kostnader för prissamordningar på den svenska generikamarknaden2018Rapport (Övrigt vetenskapligt)
    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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    fulltext
  • 44.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Rudholm, Niklas
    Department of Economics, Dalarna University, Borlänge, Sweden.
    The prescribing physician's influence on consumer choice between medically equivalent pharmaceuticals2012Ingår i: Review of Industrial Organization, ISSN 0889-938X, E-ISSN 1573-7160, Vol. 41, nr 3, s. 207-222Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper reports on a study of the prescribing physician's influence on consumers' choice between medically equivalent pharmaceuticals. The study was performed using a dataset of 666,000 observations in which consumers were asked whether they were prepared to pay the price difference in order to obtain the prescribed pharmaceutical instead of the cheapest available substitute. The main results support the hypothesis that prescribing physicians have an impact on consumers' choice between medically equivalent pharmaceutical products.

    Ladda ner fulltext (pdf)
    The prescribing physician's influence on consumer choice
  • 45.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Rudholm, Niklas
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Wikström, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för nationalekonomi.
    Fixed budgets as a cost containment measure for pharmaceuticals2006Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 7, nr 1, s. 37-45Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    In Västerbotten County, Sweden, there are two health centers which (in contrast to all other health centers in the region) bear strict responsibility over their pharmaceutical budget. This study examined whether the prices and quantities of pharmaceuticals prescribed by physicians working at these health centers differ significantly from those prescribed by physicians at health centers with open-ended budgets. Estimation results using matching methods, which allows us to compare similar patients at the different health centers, show that the introduction of fixed pharmaceutical budgets did not affect physicians' prescription behavior, indicating that fixed budgets may not be an efficient measure to reduce costs. Another explanation is that the health centers under study already had taken measures to contain costs, making it hard to further reduce costs.

    Ladda ner fulltext (pdf)
    Fixed budgets as a cost containment measure for pharmaceuticals
  • 46.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Sundström, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Physicians prescribing originals causes welfare losses2018Ingår i: Economics Letters, ISSN 0165-1765, E-ISSN 1873-7374, Vol. 170, s. 143-146Artikel i tidskrift (Refereegranskat)
    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.

  • 47.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Wikström, Magnus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Public Provision and Cross-Border Health Care2016Ingår i: Forum for Health Economics & Policy, E-ISSN 1558-9544, Vol. 19, nr 2, s. 157-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We study how the optimal public provision of health care depends on whether or not individuals have an option to seek publicly financed treatment in other regions. We find that, relative to the first-best solution, the government has an incentive to over-provide health care to low-income individuals. When cross-border health care takes place, this incentive is solely explained by that over-provision facilitates redistribution. The reason why more health care facilitates redistribution is that high-ability individuals mimicking low-ability individuals benefit the least from health care when health and labor supply are complements. Without cross-border health care, higher demand for health care among high-income individuals also contributes to the over-provision given that high-income individuals do not work considerably less than low-income individuals and that the government cannot discriminate between the income groups by giving them different access to health care.

    Ladda ner fulltext (pdf)
    fulltext
  • 48.
    Granlund, David
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    Zykova, Yana V.
    Can Private Provision of Primary Care Contribute to the Spread of Antibiotic Resistance?: A Study of Antibiotic Prescription in Sweden2021Ingår i: PharmacoEconomics - Open, ISSN 2509-4262, Vol. 5, nr 2, s. 187-195Artikel i tidskrift (Refereegranskat)
    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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  • 49.
    Janssen, Aljoscha
    et al.
    Singapore Management University, Department of Economics, 90 Stamford Rd, Singapore.
    Granlund, David
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Nationalekonomi.
    The importance of the first generic substitution: Evidence from Sweden2023Ingår i: Journal of Economic Behavior and Organization, ISSN 0167-2681, E-ISSN 1879-1751, Vol. 213, s. 1-25Artikel i tidskrift (Refereegranskat)
    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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