从搭便车者到创新者：中国药物开发的崛起（英）

FROM FREE RIDER TO INNOVATOR:THE RISE OF CHINA'S DRUG DEVELOPMENT Panle Jia BarwickHongyuan XiaTianli Xia Working Paper 34977http://www.nber.org/papers/w34977 NATIONAL BUREAU OF ECONOMIC RESEARCH1050 Massachusetts AvenueCambridge, MA 02138March 2026 We are grateful to SinoHealth for generously providing the data. We thank Shizhe Yu andCongrongPan for providing stellar research support and Leila Agha, Pierre Azoulay, TravisBaseler, Jack Collison,Rebekah Dix, Florian Ederer (discussant), Yufeng Huang, CharlesHodgson, Hanming Fang, RussellMorton, Ellie Prager, Chris Snyder, Fiona Scott Morton, andseminar participants for helpful comments.Barwick acknowledges the support from UW-Madison’s VCGRR with funding from the WisconsinAlumni Research Foundation. The views NBER working papers are circulated for discussion and comment purposes. They have not beenpeer-reviewed or been subject to the review by the NBER Board of Directors that accompanies © 2026 by Panle Jia Barwick, Hongyuan Xia, and Tianli Xia. All rights reserved. Short sections oftext, not to exceed two paragraphs, may be quoted without explicit permission provided that full From Free Rider to Innovator: The Rise of China's Drug DevelopmentPanle Jia Barwick, Hongyuan Xia, and Tianli XiaNBER Working Paper No. 34977 ABSTRACT This paper examines China’s transition from pharmaceutical “free rider” to global innovator overthelast decade. In 2010, China accounted for less than 8% of global clinical trials; by 2020, it hadsurpassedthe US in annual registered clinical trial volume. To study this transformation, wecompile a comprehensive,synchronized database spanning the pharmaceutical drug developmentsupply chain, covering scientificpublications, clinical trials, drug development milestones forChina, the U.S., and Europe, alongsidedrug sales and government policies over the same period.We provide strong evidence that China’srise was primarily driven by the National ReimbursementDrug List (NRDL) reform, which dramaticallyexpanded the effective market size for innovativedrugs. We document a sharp rise in both the quantity(86% increase) and novelty of drug trials post Panle Jia BarwickUniversity of Wisconsin - MadisonDepartment of Economicsand CEPR Tianli XiaUniversity of RochesterSimon Business School Hongyuan XiaCornell University 1Introduction Since World War II, the global landscape of the pharmaceutical industry has been defined by a clearhierarchy. The US serves as the undisputed leader in upstream R&D, generating the vast majorityof novel drug concepts and first-in-class therapies, with Europe and Japan serving as a strong second This hierarchy aligns with the conventional wisdom among health economists:smaller or low-income nations optimally rely on the diffusion of innovation from wealthy nations rather than investingin indigenous creation (Olson and Zeckhauser, 1966; Kyle, 2007; Dubois et al., 2015; Lakdawalla, This paper challenges this conventional wisdom and asks two questions. First, can a country movefrom a downstream consumer to an upstream innovator in drug development? Second, what forces To answer the first research question, we draw on the Citeline TrialTrove database, a comprehen-sive census of global drug development projects that allows us to track the life cycle of clinical R&Dwith granular detail across therapeutic areas. We document a striking structural shift in the global To formally evaluate China’s catch-up in innovation, in addition to showing the raw data, weemploy an event-study framework that benchmarks China’s trajectory against the U.S., the globalfrontier in biomedical research. We use Europe as an alternative counterfactual to ensure robustness. The event study confirms a sharp structural break in China’s clinical trial activity beginning in 2016,preceded by a flat pre-trend. By 2024, China’s annual trial volume had expanded by 172% relative China’s catch-up has three remarkable features worth highlighting.First, this expansion is notdriven by low-value “me-too” testing. By 2024, China’s high-novelty trials had increased by 49-123%relative to the U.S. across three novelty measures we construct: (1) Dranove et al. (2022)’s noveltyscore, (2) trials on new molecules (non-generics), and (3) trials using patented drugs rather thanplacebos or off-patent drugs as a control arm.Second, the surge in domestic innovation extends To answer the second research question and to causally examine the underlying drivers of thistransformation, we integrate the trial registries with complementary data sources at the country-disease-year level, including (a) global scholarly publications and author affiliations from OpenAlex; We argue that China’s transformation was not an incidental byproduct of aggregate economicgrowth, but the consequence of a specific policy shock: the 2016 National Reimbursement Drug List intensity across disease categories. We first show that the NRDL’s quantity expansion dominates itsprice contraction,