Price Subsidies, Diagnostic Tests, and Targeting of Malaria Treatment: Evidence from a Randomized Controlled Trial

Both under- and over-treatment of communicable diseases are public bads. But efforts to decrease one run the risk of increasing the other. Using rich experimental data on household treatment-seeking behavior in Kenya, we study the implications of this tradeoff for subsidizing life-saving antimalarials sold over-the-counter at retail drug outlets. We show that a very high subsidy (such as the one under consideration by the international community) dramatically increases access, but nearly half of subsidized pills go to patients without malaria. We study two ways to better target subsidized drugs: reducing the subsidy level and introducing rapid malaria tests over-the-counter.

传染病治疗不足与过度治疗均属于公共公害（public bads）。但针对其中任一问题的治理尝试，均存在加剧另一问题的风险。本研究借助肯尼亚家庭就医行为的丰富实验数据，针对零售药店非处方（over-the-counter）售卖的救命抗疟药物补贴政策，分析该权衡取舍的影响。研究结果表明，高额补贴（如国际社会正在审议的补贴方案）可大幅提升药物可及性，但近半数补贴药物会流向未感染疟疾的患者。本研究还探讨了两种可优化补贴药物靶向投放的路径：降低补贴力度，以及引入非处方快速疟疾检测试剂。