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Price Discrimination and Bargaining Power in the Global Vaccine Market

By Linda Li

Since the 1980’s, the market structure of vaccines has become increasingly oligopolistic, and in some cases monopolistic. Alongside these supply trends, we see the emergence and growth of group procurement schemes on the demand side of the market. National government and international organization procure vaccines on behalf of end users. Two such organizations include the UNICEF Supply Division and the PAHO EPI Revolving Fund, for which participation is based on income or geography. Consistent with one of the main goals of group procurement, these groups obtain price discounts on vaccines relative to the private sector. This paper seeks to disentangle two possible explanations for this observed price dispersion using vaccine price data over the years 2002-2012 from UNICEF, PAHO, and the U.S. The two explanations are that of price discrimination and bargaining power. Using proxy variables in a fixed effects model, I find that price discrimination does have a significant impact on price discount. I also find support for a bargaining power effect, however with less certainty, and the existence of supply constraints. These findings have important policy implications for national governments, as well as procurement groups.

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Advisor: David Ridley | JEL Codes: I11, I18, L22 | Tagged: Bargaining Power, Group Procurement, Price Discrimination, Vaaccines

Debunking the Cost-Shifting Myth: An Analysis of Dnamic Price Discrimination in California Hospitals

By Omar Nazzal

Cost-shifting, a dynamic form of price discrimination, is a phenomenon in which hospitals shift the burden of decreases in government-sponsored healthcare reimbursement rates to private health insurers. In this paper, I construct a data set spanning 2007 – 2011 that matches financial metrics of California hospitals to hospital- and market-specific characteristics with theoretical implications in price discrimination. The subsequent analysis is split into three stages. In the first and second stages, I use a fixed-effects OLS model to derive a point estimate of the inverse correlation between private revenue and government revenue that is consistent with recent empirical work in cost-shifting, a body of literature almost entirely reliant upon fixed-effects and difference-in-difference OLS. These types of models are encumbered by the inherent causality loop connecting public and private payment sources. I address this endogeneity problem in the third stage by specifying a fixed-effects 2SLS model based on an instrument for government revenue constructed with data from the California Department of Health Care Services and the U.S. Census. This instrument performed well in canonical tests for relevance and validity. I find that an increase in government payments causes an increase in private payments, and that the relationship is statistically-significant at all reasonable levels. In addition, I comment on properties of the data set that suggest that the original inverse correlation was due to inadequate measurements of market power. I conclude with policy implications and suggestions for future research.

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Advisor: Frank Sloan | JEL Codes: I11, I13, I18, L11, L80 | Tagged: Health Insurance, Market Structure, Medicaid, Medicare, Price Discrimination

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