FACTORS AFFECT THE BARGAINING BETWEEN PHARM AND INSURERS

医疗保健市场在过去几年发生了巨大变化。 十年 面对不断上升的成本，保险公司采取了更多的 在与医疗服务提供者就医疗价格进行谈判方面发挥积极作用 护理服务。 零售药店贸易组织认为， 新的保险公司讨价还价策略导致药店关闭或 削减服务，这可能会导致整体医疗保健的增加 成本因此，这些组织要求以各种形式 立法救济。 不幸的是，以前很少有 研究指导立法者权衡这些问题的利弊 提案 为了填补这一信息空白，本研究将模拟 药房和保险公司在价格谈判中的议价能力 并测试议价能力是否随 医药、保险、医药市场结构。 一个来自讨价还价理论的经验模型将涉及 保险公司/药房议价能力的一组变量，描述 制药、保险公司和制药市场的特点。一 这个模型的一个变体最初被用于布鲁克斯、多尔和黄 （1997 a）描述医院和保险公司的议价能力。 一个独特 前所未有的数据源组合将被用于 估计这个模型。这些来源包括药房的宇宙 1994年Medstat Marketscan数据库索赔;数据库 包含平均零售药店现金价格和成本， 1994年Source Informatics，inc.的三位数邮政编码级别; a 数据库包含所有持牌药店的名称和地址 1994年，美国国家处方药理事会 计划（NCPDP）;和邮政编码级别的社会经济数据， 人口普查局。

The medical care marketplace has changed dramatically over the last decade. In the face of escalating costs, insurers have taken a more active role in bargaining with providers over the prices of health care services. Retail pharmacy trade organizations argue that the new insurer bargaining strategies are causing pharmacies to close or curtail services, which may lead to increased overall health care costs. As a result, these organizations have asked for various forms of legislative relief. Unfortunately, there has been little previous research to guide legislators in weighing the pros and cons of these proposals. To fill this information gap, this research will model the bargaining power of pharmacies and insurers in price negotiations and test whether bargaining power varies with characteristics of the pharmacy, insurer, and pharmacy market structure. An empirical model derived from bargaining theory will relate insurer/pharmacy bargaining power to a set of variables that describe characteristics of the pharmacy, insurer, and the pharmacy market. A variant of this model was originally used in Brooks, Dor, and Wong (1997a) to describe hospital and insurer bargaining power. A unique and unprecedented combination of data sources will be used to estimate this model. These sources include the universe of pharmacy claims for the 1994 Medstat Marketscan Database; a database containing average retail pharmacy cash prices and costs at the three-digit zip code-level in 1994 from Source Informatics, inc,; a database containing the name and address of all licensed pharmacies in the U.S. in 1994 from the National Council of Prescription Drug Programs (NCPDP); and zip code level socioeconomic data from the Census Bureau.