Essays in Health Economics and Health Information Systems

Abstract

The accelerating cost of healthcare in the United States has prompted increased policy debate. Although it is estimated that prescription drug spending accounts for only eleven percent of total healthcare expenditures, there is evidence that this rate of spending is increasing faster than spending on other types of healthcare. A proven method of decreasing prescription drug spending is by using less expensive generic medications when available. We estimate the price elasticities of switching from branded to generic drugs in three dominant drug classes: antidepressants, statins, and central nervous system agents. We find the price elasticities of switching varies by drug and is between 0.01 and 0.09.Despite long-standing use of mandatory generic substitution laws, their exact effect on generic fill-rate and prescription drug spending has not been identified. We use the Tennessee Affordable Drug Act of 2005 to identify the effect of implementing the mandatory generic substitution of drugs by pharmacists. Using a differences-in-differences framework, we estimate the effect of this policy on the percentage of generic drugs dispensed in the state of Tennessee. We find the effect to vary across drug classes and health insurance types, with the greatest effect occurring within Point of Service insurance plans among non-chronic prescription drug users. We propose extensions to the technology acceptance model (TAM) for the adoption of integrated electronic health records that are shared by multiple healthcare providers. In particular, we propose a conceptual model in which we incorporate two new factors &mdash trust and access to shared information &mdash into the TAM. We find a statistically significant effect of shared information on perceived usefulness. We also find a significant effect of trust on both perceived usefulness and behavioral intent to use integrated electronic health records. Our analysis provides insights into the effects of these factors on intent to use integrated electronic health records for both clinical and non-clinical staff