Farasat A. S. Bokhari

School accountability laws and the consumption of psychostimulants

Over the past decade, several states introduced varying degrees of accountability systems for schools, which became federal law with the passage of the No Child Left Behind Act of 2001. The intent of these accountability laws was to improve academic performance and to make school quality more observable. Nonetheless, schools have reacted to these pressures in several different ways, some of which were not intended. We make use of the variation across states and over time in specific provisions of these accountability laws and find that accountability pressures effect medical diagnoses and subsequent treatment options of school aged children. Specifically, children in states with more stringent accountability laws are more likely to be diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) and consequently prescribed psychostimulant drugs for controlling the symptoms. However, conditional on diagnosis, accountability laws do not further change the probability of receiving medication therapy.

Open Versus Closed Firms and the Dynamics of Industry Evolution

We develop a model of industry evolution in which firms choose proprietary standards (closed firm) or adopt a common standard (open firm). A closed entrant can capture multiple profits whereas an open entrant faces lower entry barriers: The odds of closed entry (relative to open entry) decrease with price and eventually open entry becomes more likely. While initially closed firms have better survival because they can offset losses in one component with profits from another, the situation is reversed when prices fall below a threshold. These entry and exit dynamics can lead the industry away from its long run equilibrium.

Entry in the ADHD drugs market: Welfare impact of generics and me‐too's

Recent decades have seen a growth in treatments for attention deficit hyperactivity disorder (ADHD) including many branded and generic drugs. In the early 2000s, new drug entry dramatically altered market shares. We estimate a demand system for ADHD drugs and assess the welfare impact of new drugs. We find that entry induced large welfare gains by reducing prices of substitute drugs, and by providing alternative delivery mechanisms for existing molecules. Our results suggest that the success of follow-on patented drugs may come from unanticipated innovations like delivery mechanisms, a factor ignored by proposals to retard new follow-on drug approvals.

Selective admission into stroke unit and patient outcomes: a tale of four cities

AbstractCare of stroke patients costs considerably more in specialized stroke units (SU) compared to care in general medical wards (GMW) but the technology may be cost effective if it leads to significantly improved outcomes. While randomized control trials show better outcomes for stroke patients admitted to SU, observational studies report mixed findings. In this paper we use individual level data from first-ever stroke patients in four European cities and find evidence of selection by the initial severity of stroke into SU in some cities. In these cases, the impact of admission to SU on outcomes is overestimated by multivariate logit models even after controlling for case-mix. However, when the imbalance in patient characteristics and severity of stroke by admission to SU and GMW is adjusted using propensity score methods, the differences in outcomes are no longer statistically significant in most cases. Our analysis explains why earlier studies using observational data have found mixed results on the benefits of admission to SU.

Returns to Specialization, Transaction Costs, and the Dynamics of Industry Evolution †

When more than one component or activity is needed to produce the final product, a firm may use proprietary standards or adopt a common standard to integrate these components. We call these closed and open firms respectively, and develop a model of industry evolution to study the process by which type of firm comes to dominate the industry. Our simulations show that an industry may diverge from its long run equilibrium configuration for sustained periods of time. Typically, the industry is dominated by closed firms in the early history and by open firms later on. Entry and exit dynamics create transient biases in favor of open firms. First, a closed entrant can capture multiple profits whereas an open entrant faces a lower entry barrier. However, while the odds of closed entry (relative to open entry) are initially greater than one, they decrease with price and eventually open entry becomes more likely than closed entry. Second, though initially closed firms can offset losses in one component with profits from another and thereby have better survival as compared to open firms, when prices fall below a threshold level, a closed firm is more likely to exit than a comparable pair of open firms. Finally, entry by an open firm improves the relative odds of entry by a complementary open firm, especially when the two complementary sectors differ in size or efficiency.

Managed Care and the Adoption of Hospital Technology: The Case of Cardiac Catheterization

The diffusion of health care technology is influenced by both the total market share of managed care organizations as well as the level of competition among them. This paper differentiates between HMO penetration and competition and examines their relationship to the adoption of cardiac catheterization laboratories in all non-federal, short-term general community hospitals in the U.S. between 1985 and 1995. Results show that a hospital is less likely to adopt the technology if HMO market penetration increases but more likely to adopt if HMO competition increases. Further, the latter effect is non-linear in the number of adopters. In markets where fewer than a critical number of neighboring hospitals have already adopted, the probability of adoption increases with the number of HMOs, but in markets where more than the critical number of neighbors have already adopted, the probability of adoption decreases with the number of HMOs. Thus, in markets where technology is rare, HMO penetration and competition have countervailing effects on the diffusion of technology such that the net effect could be small.

Demand Estimation and Merger Simulations for Drugs: Logits v. AIDS

We uses ADHD drugs sales data from 2000-2003 and compare estimates of elasticities and merger simulations from three different demand models. Models include logit, random coefficients logit, and conditional AIDS demand model with multistage budgeting. The magnitude of cross-price elasticities is large in the third model in comparison to the first two, and some of the cross-price elasticities are estimated to be negative. Hypothetical merger simulations show large price effects for the multistage AIDS model in comparison to the discrete choice models.We uses ADHD drugs sales data from 2000-2003 and compare estimates of elasticities and merger simulations from three different demand models. Models include logit, random coefficients logit, and conditional AIDS demand model with multistage budgeting. The magnitude of cross-price elasticities is large in the third model in comparison to the first two, and some of the cross-price elasticities are estimated to be negative. Consequently, hypothetical merger simulations show large price effects for the multistage AIDS model, both for the merging firms as well as for the competitors, in comparison to the other two discrete choice models.

Entry Limiting Agreements for Pharmaceuticals: Pay-to-Delay and Authorized Generic Deals

Pay-to-delay deals involve a payment from a branded drug manufacturer to a generic maker to delay entry. In return, the generic receives a payment and/or an authorized licensed entry at a later date but before the patent expiration. We examine why such deals are stable. We combine the first mover advantage for the first generic with the ability of the branded manufacturer to launch an authorized generic to show when pay-to-delay deals are an equilibrium outcome. Policy simulations show that removing the ability to launch authorized generics will deter such deals but removing exclusivity period for first generic will not.

Growth and Returns to New Products and Pack Varieties: The Case of UK Pharmaceuticals

New drug introductions are a key to growth for pharmaceutical firms. However not all innovations are the same and they may have differential effects that vary by firm size. We use quarterly sales data on UK pharmaceuticals in a dynamic panel model to estimate the impact of product (new drugs) and marketing (additional pack varieties) innovations within a therapeutic class on a firms business unit growth. We find that product innovations lead to substantial growth in both the short and long run, whereas a new pack variety only produces short-term effects. The strategies are substitutes but the marginal effects are larger for product innovations relative to additional packs, and the effects are larger for smaller business units. Nonetheless, pack introductions offer a viable short-term growth strategy, especially for small and medium sized businesses.

Does Managed Care Matter? Hospital Utilization in the U.S. Between 1985 and 1993

This paper examines the effect of HMO market development on hospital utilization in short term general hospitals in the U.S. between 1985 and 1993. HMO penetration does not explain the majority or even a substantial minority of the variation in hospital utilization. Among seven measures of hospital utilization, the association between inpatient days per capita and variation in HMO penetration is the strongest with 20% of the 9% decrease in inpatient days attributable to HMOs. The association between HMO penetration and other utilization measures is even smaller. The results suggest that change in hospital utilization over the period 1985 to 1993 was attributable more to factors such as technological change than to HMOs.