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By 2014, national health expenditures are expected to exceed $3 trillion dollars in the United States as an estimated 22 million individuals gain health insurance coverage under the Patient Protection and Affordable Care Act (Keehan et al., 2012). In this recovering--perhaps fragile--economy, public and private plan sponsors are seeking ways of reigning in health care costs, while maintaining access to and quality of care. New vintages of prescription drugs have provided attractive returns on investment (e.g., Lichtenberg, 2008). Yet, nearly half of the 133 million Americans living with at least one chronic disease (CDC, 2010) do not take their medications as directed by their treatment providers (WHO, 2003). This public health problem of patient nonadherence reportedly costs the U.S. health care system $290 billion annually (NEHI, 2009). This dissertation is comprised of three essays that examine the economics of prescription drugs. Specifically, the value of medication adherence is estimated in terms of its offsetting effects on the utilization and costs of other health services. The impact of adherence on worker absenteeism and short-term disability is also investigated. Finally, since patient cost-sharing is often cited as a key compliance barrier, the price elasticity of demand for prescription drugs is rigorously measured to gain insight into whether or not Value Based Insurance Design represents a cost-effective tool for improving medication adherence. |
