Three essays evaluating the impact of public policy on pharmaceutical markets and public health
Yarbrough, Courtney Rae
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Pharmaceuticals make up a large and growing portion of national health expenditures in the United States, and the market for prescription drugs is subject to a wide range of public policies. This work contains three essays analyzing the impacts of specific policies related to pharmaceuticals. First, I estimate the effect of protected classes on expenditures and utilization for drugs in the Medicare Part D program using the synthetic control method. I find a substantial increase in expenditures for drugs in protected classes—more than $1 billion more per class per year—relative to those in a matched synthetic control group. Second, using a difference-in-differences framework, I measure the changes in opioid painkiller prescribing among doctors in states that implemented prescription drug monitoring programs between 2010 and 2013. Despite the proliferation of these programs and the dire nature of the opioid epidemic, I find only small or insignificant effects for monitoring programs on prescribing. Finally, I develop measures of social capital at the county and state levels using factor analysis to better understand the relationship between vaccination rates and a community’s level of social capital. The results of this study provide support that high levels of social capital can be important for encouraging activities like vaccinations that entail positive externalities. However, social capital can also be a conduit for misinformation or anxiety, where such forces are strong, thus discouraging vaccination. Each of these essays addresses an issue that continues to garner significant public attention. These findings highlight some of the challenges and trade-offs that addressing these issues will entail.