This thesis explores how decision-making agency roles played by
doctors, pharmacists and government affect the social efficiency of
choices in the prescription drug market. The primary objective is to
contribute to the quality of expenditure decompositions in this sector
and, thereby, to draw attention to the real cost of drug consumption in
Canada. Expenditure growth in the pharmaceutical sector may occur
because Canadians are purchasing more drugs or more in terms of the
health outcomes sought through drug consumption. Prices may also
be rising for the drugs that patients consume. Furthermore, with new
generations of prescription drugs replacing older and often equally
effective ones, expenditure inflation may be due, at least in part, to
growing inefficiencies in consumption. Deflating nominal
expenditures with traditional economic price indexes is a commonly
used approach to decomposing expenditure changes into changes in
price, changes in productivity or both. This method may be biased
because decision-making agency relationships and non-standard
financial incentives give rise to possible inefficiencies in the
pharmaceutical sector that would not commonly be found in other
sectors. This proposition is explored theoretically and empirically.
Potential biases stemming from financial incentives are explored in
the context of the measurement problem posed by the entry of generic
drugs. Traditional techniques of the economic approach to
measurement do not capture the full effect of generic competition
because decision-making agents do not always have incentive to
consider the full price of drugs consumed. Potential information-related
problems in pharmaceutical price and productivity
measurement are explored within the context of the hypertension
market. Health outcomes based indexes are constructed for this
treatment category based on recognized national guidelines for the
treatment of hypertension. Economic indexes of price and
productivity appear to overstate social productivity in this segment
because persistent non-compliance with national guidelines has
resulted in higher costs without corresponding health improvements.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:BVAU.2429/10830 |
| Date | 05 1900 |
| Creators | Morgan, Steven George |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Relation | UBC Retrospective Theses Digitization Project [http://www.library.ubc.ca/archives/retro_theses/] |
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