Ya Ming Liu

The impact of brand equity on brand preference and purchase intentions in the service industries

The antecedents of brand equity are considered to be brand attitude and brand image, and the consequences of brand equity are considered to be brand preference and purchase intentions. This study concentrates on service brands, selecting 18 from 3 service categories. A structural equation model is presented. Not only does it show a good fit with the research constructs but also the relationships between brand image and brand equity, and brand attitude and brand equity. The impact of brand equity on customer preference and purchase intentions is confirmed as well, which tends to validate the proposed research framework.

Financial incentives and physicians' prescription decisions on the choice between brand-name and generic drugs: evidence from Taiwan.

This paper tests the hypothesis of whether or not financial incentives affect a physicians prescription decision on the choice of generic versus brand-name drugs within a system in which physicians prescribe and dispense drugs. By using data obtained from Taiwan and focusing on diabetic patients, our empirical results provide several consistent findings in support of the hypothesis that profit incentives do affect the physicians prescribing decision, suggesting that physicians act as imperfect agents. An important implication of our findings is that rent seeking for profit margin between the reimbursement and the acquisition price instead of reducing costs is the major driving force behind generic substitution. As a result, the providers instead of the payers or consumers reap the financial benefits of generic substitution.

Recent trends in the use of antidiabetic medications from 2008 to 2013: A nation‐wide population‐based study from Taiwan

Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase‐4 inhibitors [DPP‐4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP‐4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs.

Regulation and competition in the Taiwanese pharmaceutical market under national health insurance.

This article investigates the determinants of the prices of pharmaceuticals and their impact on the demand for prescription drugs in the context of Taiwans pharmaceutical market where medical providers earn profit directly from prescribing and dispensing drugs. Based on product-level data, we find evidence that the profit-seeking behavior of the medical providers in the prescription drug market transfers the force of competition from the unregulated wholesale market to the regulated retail market and hence market competition still plays an important role in the determination of the regulated price. We also find that the profit-seeking behavior plays a similar role to advertising in that it increases the brand loyalty and hence lowers price elasticity. An important implication of our study is that the institutional features in the pharmaceutical market matter in shaping the nature of pharmaceutical competition and the responsiveness of pharmaceutical consumption with respect to changes in price.

Recent trends in utilization of antidiabetic medications from 2008-2013: a nation-wide population-based study from Taiwan.

Studies from other countries indicate that utilization patterns of antidiabetic drugs change significantly after the introduction of newer classes of antidiabetic drugs (e.g. dipeptidyl peptidase‐4 inhibitors [DPP‐4i]). Evidence on recent trends regarding antidiabetic drug use in Taiwan is lacking, especially for times after the introduction of newer classes of drugs (e.g. DPP‐4i). Therefore, the aim of the present study was to assess: (i) recent trends in the use and spending on antidiabetic drugs; (ii) changes in utilization patterns after introduction of newer classes of antidiabetic drugs; and (iii) factors associated with the choice of newer versus older classes of antidiabetic drugs.

New drugs and the growth of health expenditure: evidence from diabetic patients in Taiwan

This paper contributes to the growing body of literature that debates whether the adoption of pharmaceutical innovation increases the overall expenditure on health care. By examining data obtained from Taiwan and focusing on diabetic patients, we use a new class of drugs, namely, thiazolidinediones, as an example to investigate the effect on health expenditure of prescribing new drugs to patients by focusing on the impact of treatment substitution and treatment expansion. Overall, our results indicate that the introduction of new drugs mainly impacts the outpatient drug expenditure and does not give rise to any offsetting effect on other outpatient and inpatient health expenditures. This suggests that the adoption of pharmaceutical innovation in treating diabetic patients is expenditure-increasing. In addition, we find evidence that the treatment substitution channel has a more significant impact on the level of health expenditure than the treatment expansion channel. An important policy implication for our finding is that the justification for increasing health expenditure on the treatment of diabetes is not conditional upon a lowering in the demand for other types of health-care services. By contrast, it is conditional upon the increased health benefits per se.

The effect of competition on the practice of outpatient services for diabetes patients at different levels of hospitals in Taiwan

This paper empirically analyses hospital non-price competition in a market characterized by a government accreditation system in Taiwan. Outpatient services for diabetes patients were used to measure the quality of patient care in outpatient departments in three types of hospitals. The hypothesis that an increase in the number of highest accredited hospitals – medical centres – would improve the quality of care in other types of hospitals is rejected. However, after carefully controlling endogeneity and measurement error of the hospital competition index by using instrumental variables, empirical findings based on the National Health Insurance Research Database from 1997 to 1999 show that different types of hospitals may respond to competitive pressure from the various levels of hospitals differently. Positive spillover effects were found from competition from regional and district hospitals. These findings may deserve serious consideration when forming policy to allocate medical resources to different levels of hospitals.

Determinants of generic entry in the regulated Taiwanese prescription drug market

OBJECTIVES This paper investigates the determinants of generic entry in the regulated Taiwanese prescription drug market, where physicians both prescribe and dispense drugs. METHODS Using a sample of 29 ingredients and a population claim data set from 1997-2007, we employ the negative binomial regression to empirically examine the determinants of generic entry in Taiwan. RESULTS This study finds that the lagged number of competitors, market size, and market share of large-scale medical providers affect generic entry. CONCLUSIONS The negative effect of large buyers on generic entry implies that rent-seeking behavior appears to create a barrier for generic manufacturers to enter into the Taiwanese prescription drug market.

Comparative cost-effectiveness of metformin-based dual therapies associated with risk of cardiovascular diseases among Chinese patients with type 2 diabetes: Evidence from a population-based national cohort in Taiwan

OBJECTIVE To assess the cost-effectiveness of metformin-based dual therapies associated with cardiovascular disease (CVD) risk in a Chinese population with type 2 diabetes. METHODS We utilized Taiwans National Health Insurance Research Database (NHIRD) 1997-2011, which is derived from the claims of National Health Insurance, a mandatory-enrollment single-payer system that covers over 99% of Taiwans population. Four metformin-based dual therapy cohorts were used, namely a reference group of metformin plus sulfonylureas (Metformin-SU) and metformin plus acarbose, metformin plus thiazolidinediones (Metformin-TZD), and metformin plus glinides (Metformin-glinides). Using propensity scores, each subject in a comparison cohort was 1:1 matched to a referent. The effectiveness outcome was CVD risk. Only direct medical costs were included. The Markov chain model was applied to project lifetime outcomes, discounted at 3% per annum. The bootstrapping technique was performed to assess uncertainty in analysis. RESULTS Metformin-glinides was most cost-effective in the base-case analysis; Metformin-glinides saved

Availability, Health-Care Costs, and Utilization Patterns of Biologics in Taiwan

194 USD for one percentage point of reduction in CVD risk, as compared to Metformin-SU. However, for the elderly or those with severe diabetic complications, Metformin-TZD, especially pioglitazone, was more suitable; as compared to Metformin-SU, Metformin-TZD saved