Technological change in health care: Why are opinions so divided?

This paper purports to explain the widespread scepticism towards technological change in health care in general and pharmaceutical innovation in particular in the face of very high estimated rates of social return. These estimates are based on observable market prices and quantities, which are used for measuring the additional consumer surplus induced by an innovation. They grossly overstate true surplus due to the effect of insurance, however. For true demand for health care services and hence true surplus depends on the net price a patient is willing to pay, which is a rather small fraction of observed market price. The paper also outlines the conditions under which a health insurer would welcome a pharmaceutical innovation.