Public health insurers often use an implicit or explicit cost‐effectiveness threshold to determine which health products and services should be insured. We challenge the convention of a single threshold. For competitively provided products and services, prices are determined by cost; but for products with market power, patentees will increase the price according to the perceived threshold. As a result, a change in the threshold affects the prices of all patented products, including those which would have been developed even at a lower threshold. The insurer can increase efficiency by reducing the threshold for patented products, even accounting for the effect on innovation. We also model a multi‐country setting, in which thresholds for patented products will fall below the globally cooperative solution because each country does not recognize the positive externality of its own spending on innovative medicines. We show that this tragedy of the commons problem can be partly corrected through referencing other countries' thresholds, but only when the countries have similar willingness to pay.

中文翻译：

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健康成本效益阈值的经济理论：国内和国际影响

公共健康保险公司通常使用隐含或明确的成本效益阈值来确定应投保哪些健康产品和服务。我们挑战单一门槛的惯例。对于具有竞争力的产品和服务，价格由成本决定；但对于具有市场支配力的产品，专利权人会根据感知门槛提高价格。因此，门槛的变化会影响所有专利产品的价格，包括即使在较低门槛下开发的产品。保险公司可以通过降低专利产品的门槛来提高效率，甚至考虑对创新的影响。我们还模拟了一个多国环境，其中专利产品的门槛将低于全球合作解决方案，因为每个国家都没有认识到自己在创新药物上的支出的正外部性。我们表明，这种公地问题的悲剧可以通过参考其他国家的门槛来部分纠正，但前提是这些国家有类似的支付意愿。