Abstract

This thesis investigates the contribution to the growth in expenditure on medicines listed on the Pharmaceutical Benefits Scheme (PBS) from three inter-related sources: (i) the addition of new medicines offering an expanding range of treatments for disease, (ii) PBS processes for determining the prices of medicines and their conditions of listing and (iii) the demand by patients for PBS medicines. In doing so it uses trend analysis presented in both tabular and graphic form, expenditure decomposition techniques based on index and indicator numbers, and econometric analysis. Using novel techniques and interpretations, it addresses some key aspects of decomposition analysis including the treatment of new and disappearing goods and the potential bias arising from changing market shares among substitutable medicines. The analysis is undertaken for the period from 1991-92 to 2005-06. An important consequence of the cost-effectiveness and reference pricing techniques used by the PBS, is that the quantity index calculated within the decomposition of PBS expenditure can be interpreted as a measure of the quality-adjusted amount of medicines consumed by patients. This is virtually equivalent to the growth in expenditure of about 12% per annum. On average prices of medicines fell over time, modestly in nominal terms and to a greater extent in real terms. Based on the results of econometric analysis, new evidence is presented on the relative influences of copayments, safety net limits, the number of PBS medicines listed and their conditions of listing on the demand for PBS medicines by different categories of patients. Elasticities with respect to patient price are in the range -1.1 to -1.4 for General Non-Safety Net patients and in the range -0.5 to -0.9 for Concessional Non-Safety Net patients.