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Sascha G. Wolf, Medical Savings Accounts in:

Sascha G. Wolf

Pharmaceutical Expenditure in Germany, page 86 - 87

Future Development, Political Influence and Economic Impact

1. Edition 2009, ISBN print: 978-3-8329-4164-2, ISBN online: 978-3-8452-2005-5 https://doi.org/10.5771/9783845220055

Series: Neue Studien zur Politischen Ökonomie, vol. 6

Bibliographic information
86 4.6.3. Medical Savings Accounts Price development under MSAs is affected by two different kinds of patients: those that have already exceeded their MSA (their share is denoted by 1 – ?) have to pay proportional co-payments and thus give both ? rms the incentive for high prices. Contrary to that, people who are below their MSA limit (their share is denoted by ?) are highly price-sensitive because they are confronted with the whole price of the drugs. When ? = 0, the system is equivalent to simple coinsurance, but the higher the share of people who are faced with market prices, the more competition can be supposed. Therefore, it should be plausible that prices fall consistently as ? increases.78 The development of prices (? gure 4.7) coincides with this assumption. In comparison with price setting behaviour under RP and coinsurance, it is revealed that under an MSA regime prices are persistently lower – and are so without a deterioration of quality: ? does not in? uence the generic quality level. As in the coinsurance scenario, ?MSAG constantly equals tu . It can be stated that MSAs indeed increase cost-consciousness of consumers and execute competition pressure on both manufacturers. The fewer people who exceed their MSAs, the more competition arises and the more prices PMSAB and PMSAG converge on each other. Figure 4.7: Prices as a Function of ?, ? and ?. 0 0,5 1 1,5 2 2,5 3 3,5 4 4,5 0, 0/ 1 0.1, 0.1/0. 9 0.2, 0.2/0. 8 0.3, 0.3/0. 7 0.4, 0.4/0. 6 0.5, 0.5/0. 5 0.6, 0.6/0. 4 0.7, 0.7/0. 3 0.8, 0.8/0. 2 0.9, 0.9/0. 1 1, 1/ 0 Price s Price B, MSA Price G, MSA Price B, RPS Price G, RPS Price B, Co- Payment Price G, Co- Payment ?, ? / ? Notes: ?B = 1. For comparison, PRPB and PRPG as a function of ? and ? as well as PB and PG at k = r.s are in grey curves. Prices in the coinsurance-scenario are independent on curves ?, ? and ? and thus remain constant. Although the control instruments highly in? uence ? rms’ price-setting behaviour, quantities are almost not affected. In all three scenarios, quantity of drug B remains constant: qB = qRPB = qMSAB = 0.5. Likewise, for drug G we obtain: qG = qMSAG = 0.37. Only 78 Quantities remain constant at QB = 0.5 and QG = 0.37. 87 in the reference price scheme does G’s quantity vary slightly between 0.37 if ? = 0 and 0.3 if ? = 1. Consequently, ? rms’ pro? ts develop analogically to prices. Especially under an MSA regime, surpluses constantly decrease, which indicates more competition; this is opposed to RP, which only results in more competition as long as ? does not become too big (? gure 4.8). Figure 4.8: Pro? ts as a Function of ?, ? and ?. 0 0,5 1 1,5 2 2,5 0, 0/ 1 0.1, 0.1/0. 9 0.2, 0.2/0. 8 0.3, 0.3/0. 7 0.4, 0.4/0. 6 0.5, 0.5/0. 5 0.6, 0.6/0. 4 0.7, 0.7/0. 3 0.8, 0.8/0. 2 0.9, 0.9/0. 1 1, 1/ 0 Profit s ?, ? / ? Profits Co-Payment Profits MSA Profits RPS Notes: ?B = 1. 4.7. Financing Pharmaceutical Expenditure by means of Medical Savings Accounts Compared to coinsurance and RP, ? nancing drug provision via MSAs delivers more ef? cient results: increasing price competition forces manufacturers to lower prices without a deterioration in quality and without endangering comprehensive medical care. MSAs improve the cost consciousness of consumers and suppliers and reduce moral hazard welfare losses. But how far a system of MSAs can be used as a suitable option to ? nance pharmaceutical expenditure in the SHI depends on a wider set of arguments. There exist three fundamental criteria: (a) degree of coverage, (b) social security and (c) information. (a) Degree of coverage: The most important advantage of MSAs compared to RP is obvious: MSAs enable real price competition, whereas RP is only a market surrogate with an arti? cial price mechanism. Under an MSA regime, patients are obliged to pay the whole drug price themselves as long as their MSA is not empty. But when the MSA is exhausted, public subsidies are required and the control instrument loses its compe-

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Zusammenfassung

Der Arzneimittelsektor der Gesetzlichen Krankenversicherung stand wiederholt im Fokus zahlreicher Gesundheitsreformen. Dennoch ist es bislang nicht gelungen, den Trend steigender Ausgaben nachhaltig zu bremsen. Die vorliegende Untersuchung leistet einen Beitrag dazu, die Ursachen dieser Entwicklung zu erklären und Lösungsansätze aufzuzeigen. Mittels Hauptkomponenten- und Cluster-Analyse wurden Gruppen von Arzneimitteln mit vergleichbaren Konsumeigenschaften gebildet. Jede Gruppe wurde auf den Einfluss der Altersabhängigkeit und des technologischen Fortschritts hin analysiert. Aufbauend auf diesen Ergebnissen wurde eine Prognose der zukünftigen Ausgabenentwicklung bis zum Jahr 2050 erstellt. Obwohl die Hauptkostenfaktoren exogen sind, steht der Gesetzgeber dem vorhergesagten ansteigenden Kostenpfad nicht hilflos gegenüber. Im Gegenteil: Anhand ökonometrischer Tests wird gezeigt, dass die Gesundheitspolitik in der Vergangenheit durch wahl- und klientelorientierte Interessendurchsetzung geprägt war. Mehr Effizienz in der Arzneimittelversorgung könnte durch die Einführung individueller Gesundheitssparkonten erzielt werden. Dies bestätigen die Resultate eines vertikal differenzierten Wettbewerbsmodells.