ABSTRACT
Regulatory enforcement of product safety standards given health concerns, whether it is in romaine lettuce, smartphones or cars, is emerging to be a challenge for global public health. This is particularly true for developing economies with fragile institutions. In this context, recent studies on Indian pharmaceutical markets provide evidence suggesting that the sector is a hub for substandard quality of medicines. Departing from these prior studies which use randomly collected samples, we reinvestigate this question using novel pan-India market sales data of banned medicines from 0.75 million pharmacists and chemists in India. We find that indeed such medicines get sold in India even after bans are imposed on them in the period 2007 to 2013. However, there is a general decline in demand post ban for our focal molecules suggesting broad adherence to bans. We also observe regional heterogeneity in prevalence of banned medicines sold between rich and poor regions of India with the former counterintuitively showing more sales. That said, while Ozawa et al. (2018) argue that prevalence of substandard medicines is around 13% in low and middle-income countries, we find an infringement ratio which is more muted in India at about 5%. Finally, a regression-based examination suggests that prior firm presence in therapeutic markets and popularity of molecules positively impact the likelihood of sale of banned medicines in India. Our results are robust to alternative explanations and are substantiated with a theoretical set up examining firm trade-offs in the decision to infringe. India has recently been under the lens of the global access to medicines debate and our findings have important policy implications for global health.
Subject(s)
Drug and Narcotic Control/legislation & jurisprudence , Law Enforcement , Drug Costs , Drug Industry/economics , Drug Industry/legislation & jurisprudence , Drug and Narcotic Control/economics , Humans , India , Law Enforcement/methods , Legislation, Drug , Pharmaceutical Preparations/economicsABSTRACT
OBJECTIVE: To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. METHODS: Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. RESULTS: In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. CONCLUSIONS: The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the use of specialized and dental services, which favor the rich, deserves policy makers' attention and further investigation related to the quality of these services.
Subject(s)
Delivery of Health Care/statistics & numerical data , Health Status Disparities , Healthcare Disparities/statistics & numerical data , Income/statistics & numerical data , Adolescent , Adult , Aged , Chile , Female , Humans , Male , Middle Aged , Socioeconomic Factors , Time Factors , Young AdultABSTRACT
OBJECTIVE: To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. METHODS: Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. RESULTS: In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. CONCLUSIONS: The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the use of specialized and dental services, which favor the rich, deserves policy makers' attention and further investigation related to the quality of these services.
OBJETIVO: Medir y explicar las desigualdades en salud y en la utilización de la atención sanitaria relacionadas con los ingresos en Chile durante el período 2000 - 2009, evaluar sus factores determinantes y las variaciones dentro del país. MÉTODOS: Se usaron datos de las Encuestas de Caracterización Nacional Socio-económica de 2000, 2003 y 2009. La desigualdad en la utilización de la atención sanitaria relacionada con los ingresos se evaluó con los índices estandarizados de concentración para la probabilidad y el total de consultas de atención especializada, general, de urgencia, odontológica, de salud mental y hospitalaria. El estado de salud autoevaluado y las limitaciones físicas se usaron como mediciones indirectas de la necesidad de atención sanitaria. Se estandarizó por variables demográficas y de necesidad; se utilizó el método de descomposición para calcular la contribución de cada uno de los factores usados para calcular el índice de concentración, entre ellos la etnia, el estado de empleo, el seguro de salud y la región de residencia. RESULTADOS: Las personas en los quintiles de menores ingresos refirieron peor estado de salud y más limitaciones físicas que las de los quintiles superiores. Se encontraron desigualdades a favor de las personas de mayores ingresos para las consultas especializadas y odontológicas, y una leve utilización mayor en este grupo de consultas generales y totales, aunque todas han disminuido en el tiempo. La atención en salas de emergencias y las hospitalizaciones se concentraron en los quintiles de menores ingresos y han aumentado en el tiempo. Los ingresos y tener mayor educación y seguro de salud privado contribuyen a la inequidad a favor de las personas de mayores ingresos respecto de las consultas odontológicas, generales, especializadas y totales, mientras la residencia urbana y la actividad económica contribuyen a la inequidad a favor de las personas de menores ingresos respecto de las consultas en salas de emergencias. CONCLUSIONES: Los patrones de utilización de la atención sanitaria en Chile concuerdan con las políticas del país y van en la dirección esperada. La significativa desigualdad en el ingreso y en el uso de servicios odontológicos y especializados, que favorece a las personas de mayores ingresos, requiere la atención de las instancias normativas y merece investigaciones adicionales relacionadas con la calidad de estos servicios.
