Strengthening IPR causes drug prices to skyrocket – that means that Biden loses support

This study investigated how the national level of IPR is associated with individuals’ access to medicines and households’ experience of catastrophic expenditure for medicines. First, our results show that higher level of IPR is associated with low access to prescribed medicines. This adverse relationship between IPR and access to medicines is significant even after controlling for country income level and individuals’ socioeconomic status and demographic characteristics. Adding other variables, which reflect the characteristics of each country’s healthcare system, in the model did not change the significant effect of IPR on access to medicines, although the magnitude of the effect slightly decreased. These results imply that strengthened IPR for pharmaceuticals is functioning as a barrier to people’s access to medicines. Even though each country’s policy efforts, such as strengthening the infrastructure of healthcare provision and increasing the public expenditure for healthcare, have contributed to offsetting the negative impact of IPR on medicine utilization to some extent, the effect of IPR was still significant. Our results also show that IPR exerts an influence on medicine utilization only in countries above a certain income level. We did not observe the significant effect of IPR on access to medicines in low-income countries where GDP per capita is below $1000, whereas it was negatively associated with access to medicines in middle-income countries. These results are more likely to be related with access to healthcare, which is the premise of utilizing the prescription drugs. This study only included the population for whom medicines were prescribed when they visited health care providers, excluding the population who could not see healthcare providers even though they were in need. Given that a greater number of people are suffering from poor access to healthcare in low-income countries than in middle-income ones, no association between IPR and access to medicines in low-income countries is more likely to be explained by this kind of sample selection problem. Furthermore, a gap between rules and practice in the enforcement of IPR may contribute to the non-significant impact of IPR in low-income countries. As Shadlen and colleagues pointed out,41 low-income countries may have a large gap between rules and reality with regard to IPR, considering their limited resources for implementation and enforcement of IPR. The GP index that we used as an index of IPR in this study was developed by a text-based approach using the existing legal and institutional arrangements for patent systems, so it may not show us the full picture of actual protection level for IPR. Thus, we cannot exclude the possibility of this type of measurement error in low-income countries. We also found that those who live in rural areas have better access to medicines than those who live in urban areas. This may be related to sample selection process. Rural areas are likely to have inferior healthcare infrastructure, so rural residents have more difficulties in utilizing healthcare service. Because rural residents included in this study are those who visit healthcare providers despite this barrier, it is possible that they have more propensity to use healthcare, including prescribed medicines, than urban residents. This possibility is supported by the result that the coefficient of rural residence is bigger and significant in low-income countries, but not in middle-income countries, because the difference in healthcare infrastructure between rural and urban areas would be bigger in low-income countries than in middle-income ones. Next, our results show that the effects of the national healthcare system on access to medicines are not the same across countries with different income levels. Although essential medicines lists and the number of doctors had positive significant relationships with access to medicines in low-income countries, only a public share of total health expenditure had a significant impact in middle-income countries. This suggests that the main types of access barrier that countries face are different according to their income level. Middle-income countries tend to suffer from non-affordable price of medicines rather than availability problems, whereas low availability of essential medicines is a more serious issue for low-income countries. Last, our results show that IPR is not associated with households’ catastrophic expenditure for medicines even though it is significantly associated with access to prescribed medicines. This is due to the possibility that many people cannot purchase medicines at all because of their poor purchasing capacity and the high price of medicines. As a result, they are likely to be excluded from the analysis. Accordingly, the results of this study provide strong empirical evidence for the linkage between IPR and access to medicines in developing countries. As we hypothesized, strengthening IPR led to lower access to medicines in developing countries, and particularly lower access for the poorest of the poor. This result supports previous theoretical debate that patent protection may result in welfare loss in developing countries.