A Macroeconomic analysis of institutional assets and their impact in modelling pharmaceutical market in Italy

Rationale Since its institution in 1978, the National Health Service in Italy has undergone two major reforms: the first one occurred in 1992/1993 and the second one in 1999/2000. The reform process has seen the increase of the degree of decentralization and the shift in the financial responsibility for health expenditures - from the central level of government to the local level of government -). The legislative measures implemented according to the health care reforms have modified the initial scenario, leading pharmaceutical firms to adapt their strategies to the arising challenges. Objectives The aim of this study is that of analysing how the Italian pharmaceutical market has been evolving across the last decades. The strategy selection process for pharmaceutical firms, in order to adapt to changes, might depend on some structural "exogenous" factors, such as regulatory issues, concentration in the market, etc., likely to influence firms' performances. Methodology In this paper, a sample of Italian pharmaceutical firms, representing the 75% of total sales, has been observed from 1978 on, when the National Health System was set out in Italy. Estimations have been carried out through a Fully Modified-LS (Phillips-Hansen) regression, given the presence of unit roots for the variables that have been employed. Moreover, structural changes occurred in the years immediately following the reforms in the health sector have been tested. Among variables included in the analysis there are level of revenues, dummies related to institutional change, health, R&S and pharmaceutical expenditure. Results Results of this paper explain trends in pharmaceutical industry in Italy from the institution of National Health Service till 2005: first of all, structural changes have been observed few years after the main reform of 1992/93; a minor impact on firms' revenues has been observed after the reform of 1999. Even if there has been an increase in number of products and level of R&S expenditure, the latter is still influenced by the high level of regulation and pricing policies. Qualified employment in the pharmaceutical sector do exert a positive impact on firms' revenues as well as mergers and acquisitions that, along time, have led to a more concentrated market. It still needs to be clarified the sustainability of the whole system in the next years, because of the aging population and the consequent increase in health expenditure demand. A positive impact of the openned towards foreigna markets is signalled by the value of the export/import ratio. Conclusions Strategies and performances of pharmaceutical firms have to be analysed looking at macro variables instead of micro and behavioural factors only. Institutional assets do have a role in determining variations in their economic results.