Analysis of relationship between consumer behavior and effectiveness of heart medicines

652 ANALYSIS OF RELATIONSHIP BETWEEN CONSUMER BEHAVIOR AND EFFECTIVENESS OF HEART MEDICINES Ge gő Tömö i Depa men o Accoun ing and Finance, Facul y o Economic Sciences, Uni e si y o Deb ecen, Deb ecen, Hunga y ge [email protected] Abs ac : Nowadays many esea ch dealing wi h he ood consume beha io and i s ela ionship wi h heal h s a us o popula ion, hus he demand o pha maceu ical ma ke . I is well known ha ca dio ascula diseases such as ischaemic hea diseases a e he mos common cause o he ea ly and suddenly mo ali y. The highe le el o pha maceu ical p e en i e echnologies may esul pa ly ha ewe people need o consume hea medicines due o he heal hy die , on he o he hand ha he he apies can keep low he hea mo ali y a e inside o all mo ali y. E ec i eness o medicine ea ing hea diseases is no same in he examined OECD coun ies, which can also be aced back o di e en ood consump ion due o he same o ms o ea men and he isks o he disease be ween egions. The examined OECD coun ies we e selec ed based on consume da a a ailabili y. The a ge o analysis is o esea ch he ela ionship be ween he „ine ec i eness” o hea medicine consump ion ( ia he hea mo ali y da a) and he heal h awa eness in ood consump ion ha also shows he subjec i e u ili y o p e en i e heal h se ices. Du ing he examina ion o p e en i e se ices ma ke i could be conside only cos ume decisions hose mo i a e e o o ealize and maximize heal h u ili y ha can ob ain by educing he objec i e likelihood o la e illness (p e en ion de ined by he educ ion o in luenced isk ac o s). Fo his i has o be elimina ed he impac o all ac o s in consump ion hose a e no associa ed wi h heal h consciousness – calcula ion o p ice and income lexibili y se e i . E e y nu i ional cul u e conside ed unheal hy o inco ec , which exceeds he c i ical alues exp essed in die e ics ecommenda ions. The da a desc ibed in a 2 dimensional diag ams, and be ween diag ams he dis ances om e e ence coun y da a o da a o ano he coun y examine wi h co ela ion coe icien . I can conclude he e is a s onges connec ion be ween he ca bohyd a e/ a consume a es and he e ec o medical ea men s han be ween he la e and a o a /p o ein consume a es. Basically, my esea ch is empi ical and quan i a i e. Keywo ds: p ice lexibili y, heal h, consump ion, p e en ion, nu i ion, hea diseases JEL classi ica ion: I15 1. Gene ally In oduc ion Nowadays many esea ch dealing wi h he ood consump ion based on heal h awa eness and i s connec ion wi h heal h s a us o popula ion, so he demand o pha maceu ical ma ke . Acco ding o KEARNEY (2010) he nu i ion ansi ions associa ed wi h ising a es o obesi y and ch onic diseases such as ca dio ascula disease and cance . Since “ he heal h budge expendi u es ha e inc eased d ama ically o e he wo ld, due o he inc easing cos p essu e” (FRANK, 2007), i can sa e se e al ype o expendi u es in public heal h sec o wi h ollowing heal h conscious nu i ion. O e all, in Eu ope “ca dio ascula diseases esul mos ly he inabili y o wo k and aising cos s in heal h ca e, u he mo e classi y as he mos equen causes o ea ly sudden dea h” (KÉKES, 2009). “The obesi y, smoking, s ess- illed en i onmen , excessi e alcohol consump ion and lack o physical ac i i y cons i u es a g oup o li es yle- ela ed isk ac o s, which esponsible o a leas 40% o o al mo ali y in he de eloping coun ies, while 75% o o al mo ali y in he 653 indus ialize coun ies” (GÁRDOS, 2001). In con as , a s a is ical s udy based on na ow sample con ained by young people clea ly concludes ha knowledge o isk ac o s i sel has no con ibu ed o li e heal hie (BARANYAI e al., 2006.). Fo example in Hunga y „ he le el o heal h awa eness is conside ed s able, he majo i y ea comple ely no mally o oods hose as e good” (KOZÁK, 2009). Acco ding o he Wo ld Heal h S a is ics by WHO (2014) „ he p eponde ance o noncommunicable diseases (NCDs) such as ischaemic hea disease and ce eb o ascula disease in cause o dea h ankings is he e o e po en ially misleading and may no app op ia ely e lec he impac o p ema u e mo ali y”.1„O he leading 15 causes o YLL, ischaemic hea disease and s oke we e wo o he h ee causes o which YLL inc eased be ween 2000 and 2012. Such changes also ha e implica ions o o e all ankings as ischaemic hea disease o e ook lowe espi a o y in ec ions as he leading cause o YLL in he wo ld” (WHO, 2014). 2. Ma e ial and me hods The highe le el o pha maceu ical p e en i e echnologies may esul pa ly ha ewe people need o consume hea medicines due o he heal hy die , on he o he hand ha he he apies can keep low he hea mo ali y a e inside o he all mo ali y. Acco dingly, du ing he analysis he au ho illus a e he he o me easons in a diag am ha ha e 2 dimensions: he a e age d ug consump ion pe 1000 people be ween 2000 and 2011 and he disease speci ic mo ali y a e in he same pe iod (in his case o he ischaemic hea diseases). In he ood consump ion “depending on he de elopmen al s anda d o he economy, s uc u al change p oceeds along he ollowing dimensions: asso men -, con enience-, heal h- and en i onmen al ends and anspa ency o he ma ke ” (LEHOTA, 2004). Despi e o his he au ho limi ed easons o ood consump ion decisions only o h ee ac o s: he impac o eal income changes (including ood p ices and he incomes o cus ome s), he change o ood supply composi ion and a ibu ed speci ics ( ole in nu i ional cul u e, nu ien con en , expe ienced sense o sa is ac ion a e p e ious as ing, ma ke ing impac , abili y educing hunge ), and he die awa eness which include he heal h awa eness oo. Du ing he examina ion o p e en i e se ices ma ke i could be conside only cos ume decisions hose mo i a e e o o ealize and maximize medical u ili y ha can ob ain by educing he objec i e likelihood o la e illness (p e en ion de ined by he educ ion o in luenced isk ac o s). Fo his i has o be elimina ed he impac o all ac o s hose a e no associa ed wi h heal h consciousness. I can be dis inguished h ee ood ypes: a s, p o eins and ca bohyd a es – om hese ypes a ood baske could assemble. The consume ’s own decision ha whe he wo h o i d awn up he o me baske in acco dance wi h he p esc ibed a e in o de o main ain his heal h. The ex en o de ia ion om he desi able consume baske gi es one o dimensions o analysis: due o he h ee di e en ypes and i s p esumed e ec s he o me ex en has o show sepa a ely in e ms o he ene gy a ise om a in kcal, he a e o a /p o ein, he a e o ca bohyd a e/ a , ege able oils and ish consump ion, hose ha e polyunsa u a ed a s. The au ho e alua es de ia ion in e ms o he de elopmen o ischemic hea diseases: e e y nu i ional cul u e conside ed unheal hy o inco ec , which exceeds he c i ical alues exp essed in die e ics ecommenda ions. Taken in o accoun he exchange a es used o nu i ional science: a o 9.2 kcal/g, p o ein o 4.2 kcal/g, and ca bohyd a e o 4.1 kcal/g. Mo eo e , based he newes s udies, p esc ibe a e o he ene gy a ise om a is 30% o daily ene gy in ake, he a /p o ein is nea ly 1.5, he ca bohyd a e/ a is app oxima ely 1.66. The o he one o dimensions is he eason o consump ion o he gi en die composi ion, which measu ed by he sum o p ice and income lexibili y: since lowe lexibili y essen ially means g ea e die awa eness, so he au ho measu es he la e ac o as ecip ocal o sum o lexibili y a es, while he change o ood supply composi ion conside ed unchanged. The p ice and income lexibili y calcula ed by he o mula (1). 654 =𝜕󰇛󰇜 𝜕 ∗ 󰇛󰇜+𝜕󰇛𝐼󰇜 𝜕𝐼 ∗𝐼 󰇛𝐼󰇜 󰇛󰇜 In his case he ood consume decisions mo i a ing heal h awa eness can be de ec ed clea ly in he 2 dimensions model i he nu i ional consump ion, hose a e nea ly o he p esc ibed die composi ions, ha e high die awa eness (so low p ice and income lexibili y). F om conside ing p e en i e na u e o nu i ion ollows ha o he consume s i will only be wo h i o gi e up he unheal hie die , which can ha e highe u ili y in o de o a heal hie one i he u ili y o p e en ion, namely he es ima ed p obabili y o ch onic disease wi hin 10 yea s nex o he absence o p e en ion, compa ed o he es ima ed p obabili y nex o p e en ion, would e alua e o highe signi ican ly. Howe e , i die s ollowed by consume s esul u ili y pe manen ly wi hin he equi ed c i e ia, han die wi h p e en i e speci ics in eg a e in o he consume cus oms, o his eason man p e e s hese oods wi hou he u ili y o p e en ion, so in mo i a ion behind consump ion he bo de be ween he p e en ion aim and ollowing o nu i ional cus oms disappea , bu since he la e inally also based on he heal h awa eness, he au ho iden i y he impac o nu i ional cul u e wi h his. The da a desc ibed in a 2 dimensional diag am examine wi h co ela ion coe icien ( ) o ela i e dis ances (s) om e e ence coun y da a o da a o ano he coun ies. =√∆+∆ = ∑󰇛−󰇜󰇛−󰇜 √∑󰇛−󰇜󰇛−󰇜 When se ing up he model, he au ho assume ha he pha macological ea men begin a he same ime wi h disease eme gence (o cessa ion o symp om con ol), u he mo e sudden p ema u e mo ali y (be o e li e expec ancy) explained by he ailu e o medica ion. The s a ing assump ion o he model is ha all membe s o examined popula ions eed as a e age ( he annual sum o p ice and income lexibili y da a be ween 1996 and 2011 cha ac e ized by quad a ic a e age o hose, which is sui able o handle he di e en sign a ia ions) based on he OECD S a is ics and FAO da a se ices. Owing o he da a a ailabili y he examined coun ies a e OECD membe s: Hunga y, Slo akia, Ge many, I aly, Uni ed Kingdom and No way. 3. Resul s and discussion I he e ec i eness o hea medicine examined only in he pape , i will no appea so di e ences be ween coun ies, which would explain by ano he eason han heal h ca e sys em o dis inc heal h s a us o popula ion. Compa ed his o he ood consump ion, he di e ences be ween coun y da a can also explain in e ms o di e en nu i ional cul u es. 655 Figu e 1: The e ec i eness o hea medicine consump ion (2000-2012). Sou ce: own edi ing based on OECD Heal h S a is ics. Based on Figu e 1 i can diagnose ha be ween Slo akia and No way, u he mo e Ge many and Hunga y appea much g ea e di e ence in mo ali y a e in ischeamic hea disease han only di e ences in hea (blood p essu e and choles e ol lowe ing) medicines consump ion would jus i y. Mo eo e , in he UK nex o ela i ely highe d ug consump ion he disease-speci ic mo ali y a e is he same as he da a o Ge many (19%). In ela ion o each o he o six examined coun ies Slo akia is in he leas a ou able si ua ion, since ela i e o he low hea medicine consump ion, disease-speci ic mo ali y a e is high (33%), so in Slo akia he a e age e ec i eness o medicinal ea men is ex emely w ong compa ed o o he coun ies. Howe e , i can explain by he lowe medical a ailabili y, bu ha canno be said o Hunga y, whe e he mo ali y is he second highes , nex o he highes medicine consump ion ollowing he UK. Those coun ies a e in he bes posi ion, whe e beside o lowe medicine demand, he e is also lowe mo ali y a e in ischeamic hea diseases compa ed o all mo ali y, such as No way and I aly. In e ms o he a in ake he bes , uppe le qua e o coo dina e-sys em in Figu e 2, includes no one coun y – Slo akia is he only one whe e – howe e a consump ion is he lowes , he la e ha e he highes p ice and income lexibili y oo. Despi e o Slo akia, Ge many s ands ou in ha ela i ely highe a consump ion a e in luenced by die awa eness, which can explain by di e en in s anda d o li ing. Howe e , i is he wo s si ua ion oo, since he high a in ake a e a ises om he die a y cul u e ollowed by as majo i y o Ge mans, which can o med only longe e m. The majo i y o examined coun ies has low a in ake a e, bu he p ice lexibili y o consump ion is highe , so in his espec hose a e close o he mos un a o able case. The dispe sion o medicinal da a canno explain by he di e en o a meals consump ion: he la e is highe in Slo akia compa ed o No way despi e o he ac ha in No way he e is a g ea e a in ake a e by 5% a he same die awa eness as in Slo akia. Mo eo e , he la ge mo ali y a e in Hunga y can less a ibu ed o di e en a in ake, while he la e is conside ed o be mo e die conscious in Ge many. SVK HUN NOR ITA GER GBR 350,00 400,00 450,00 500,00 The a a age hea medicine consump ion (daily dose/1000 people) 10% 15% 20% 25% 30% 35% Mo ali y a e in ischaemic hea diseases      656 Figu e 2: The a e age a consump ion (1996-2011) in six OECD coun ies. Sou ce: own edi ing based on FAO S a is ics. Acco ding o he li e a u e he lipop o eins (lipid-p o ein complexes) play an ex emely ole in causing ischaemic hea diseases by inducing a he oscle osis. Acco ding o i s composi ion he e a e wo ypes o lipop o ein: high densi y lipop o eins (HDLs) is he p o ec i e choles e ol, which he LDLs ha deposi ed in essel wall anspo ed back o he li e whe e i is deg aded, so i HDL le el is low, he isk o a e ioscle osis, hea a ack and s oke will inc ease – he low densi y lipop o eins (LDLs) inc easing isk o disease would occu s ongly nex o nu i ional cul u e ha can cha ac e ized by high a con en ea ing compa ed p o eins. So inadequa e a /p o ein a io enhances he numbe o w ong choles e ols, which al eady no compensa ed by he le el o p o ec i e choles e ols, inc easing he chance o occu ence o hype lipidemia and hype ension (high blood p essu e), hus hese connec wi h he less e ec i eness o medicinal ea men healing ischaemic hea diseases. Based on da a illus a ed in Figu e 3, I aly, No way and Uni ed Kingdom ha e he mos a o able a /p o ein a io, howe e , hose ex end could no explain he leas by high die awa eness in I aly. The wo s a e can be de ec ed in Hunga y, bu he p ice and income ela ions a e mo e decisi e in ood consump ion han die consciousness. Compa ed his wi h he a e age consump ion o blood p essu e lowing medicine, i can consequence ha he medicine u iliza ion de e mined a he by an awa eness o consump ion o heal hie die (Ge many) han a less heal hy a /p o ein a e, ha consume less consciously (Hunga y). 3% 4% 5% 6% 7% 8% De ia ion om he heal hy a e o a in ake (30%) 0,00 0,50 1,00 1,50 Die awa eness o a meals consump ion       GER SVK ITA NOR HUN GBR 657 Figu e 3: The a e age a /p o ein nu i ional in ake a e (1996-2011) in six OECD coun ies. Sou ce: based on FAO S a is ics own edi ing. Figu e 4: The a e age ca bohyd a e/ a nu i ional in ake a e (1996-2011) in six OECD coun ies. Sou ce: own edi ing based on FAO S a is ics. Due o high glycemic-index ca bohyd a e in ake, he suga concen a ion de elops in he blood causing pe sis en ly highe le el o insulin. I causes ha insulin can connec mo e 1,60 1,70 1,80 1,90 De ia ion om ecommended a e (1.5) 0,00 0,25 0,50 0,75 1,00 Die awa eness o a /p o ein consump ion       GER SVK GBR NOR ITA HUN 1,20 1,30 1,40 1,50 1,60 The a a age ca bohyd a e/ a nu i ional in ake 0,25 0,50 0,75 1,00 Die awa eness o ca bohyd a e/ a consump ion      NOR GER SVK GBR HUN ITA 658 weakly o he insulin ecep o s o cells, so hose become esis an o he p esence o insulin, and p oduc ion o hose. The b ain sensing inc eased blood glucose le el, ins uc s be a cells o p oduce u he insulin, which exhaus due o he esis ance o cells and con inued high glucose le el, hus insulin de iciency o diabe es de elops, ollowed by obesi y and ca dio ascula diseases. In e ms o ca bohyd a e/ a nu i ional in ake, Slo akia is he wo s posi ion, while No way, Hunga y and I aly ha e a e ega ded as he bes – howe e he die awa eness emains ypical mos ly o No way and he leas o I aly. Compa ing his o he da a o a /p o ein in ake a es, i is concluded ha he medicine u iliza ion de e mined a he by he ca bohyd a e/ a in ake a e han he a /p o ein a e. Table 1: The a e age consump ion o ege able oils and ishes in six OECD coun ies Consump ion Ge many Hunga y I aly No way Slo akia G ea - B i ain Oils Ra e 2,1% 2,1% 2,6% 1,8% 1,8% 2,1% Awa eness 1,16 10,79 1,44 14,46 26,32 3,64 Fishes Ra e 1,4% 0,5% 2,1% 5,3% 1,0% 2,0% Awa eness 2,39 16,66 1,56 1,76 104,81 1,52 Sou ce: own edi ing based on FAO S a is ics. In espec o seconda y p e en ion o ischemic hea diseases ele an o conside he consump ion a io o ood con aining polyunsa u a ed a y acids - ege able oils and ish con ain polyunsa u a ed a y acids in he la ges p opo ion. The consump ion o ege able oils, shown in Figu e 5, is a ound 2% o he o al ood consump ion in all examined coun ies. F om his I alian a e de ia es a li le wi h i s 2.5%, while die awa eness is su p isingly low in No way. Al e na i ely, alues o ish consump ion can be al eady de ec ed in a wide in e al: while in he mos o coun ies ish meals a e ea en in 2% o less compa ed o o al ood (among o he s in he lowes p opo ion in Hunga y), he die o No wegians de e mined by mo e han 5% he consump ion o sea ood. Howe e , i conside s ha , in I aly – despi e o he esul s in he a in ake a es – he nu i ional consciousness o ege able oils and ishes is ex emely high. Thus he e ec o ollowing Medi e anean die o ood consump ion mani es s no p ima ily in con ol o nu i ion in ake a es ela ion o each o he s, bu also insis ence o ce ain ypes o ood, ega dless o i s con en , which e e s o less heal h- conscious ood consump ion. The co ela ion coe icien s o de ia ions desc ibed in Table 2. Table 2: Co ela ion be ween nu i ional cul u e and medical ea men Medical ea men Fa Fa /P o ein Ca bo- hyd a e/ a Vege able oils Fishes Co ela ion coe icien 1 0,396 -0,575 -0,856 -0,04 -0,23 Sou ce: own edi ing. Since in his analysis he p esages conside as i ele an , he e is a s onges connec ion be ween he ca bohyd a e/ a consump ion and he medical ea men . 659 4. Conclusions and Summa y In conclusion, i s ly, e ec i eness o medicine ea ing hea diseases is no same in he six examined OECD coun ies, which can also be aced back o di e en ood consump ion due o he same o ms o ea men and he isks o he disease be ween egions. The la e , howe e , may be assessed acco ding o se e al c i e ia (nu ien in ake by i sel and in ela ion o each o he , and consump ion o oods con aining less equen nu ien s), hose indica e no he same esul s conce ning e ec i eness o medical ea men . I is concluded ha he medicine u iliza ion de e mined a he by he ca bohyd a e/ a in ake a e o ish die s han he a /p o ein a e o a consump ion. 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