从搭便车者到创新者：中国药物开发的崛起

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 viewsexpressed herein are those of the authors and do not necessarilyreflect the views of the NationalBureau of Economic Research. 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 accompaniesofficialNBER publications. © 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 fullcredit,including © notice, is given to the source. From Free Rider to Innovator: The Rise of China's Drug DevelopmentPanle Jia Barwick, Hongyuan Xia, and Tianli XiaNBER Working Paper No. 34977March 2026JEL No. I18, L65, O31, O38 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 postreform, with growth concentrated in reform-exposeddisease categories, first- or best-in-classdrugs, and among domestic firms. A decomposition exercisereveals that the NRDL reformaccounts for 43% of the growth in oncology trial activity, nearly doublingthe combinedcontribution of upstream knowledge accumulation and talent flows (24%), while othergovernmentpolicies play a minor role. Finally, dynamic gains from induced innovation exceed thereform’sstatic gains in consumer access to innovative drugs by threefold, underscoring the importanceofaccounting for the reform’s long-run effects on innovation incentives in addition to near-termimprovementsin drug affordability. Tianli XiaUniversity of RochesterSimon Business SchoolDepartment of Marketingtianli.xia@rochester.edu Panle Jia BarwickUniversity of Wisconsin - MadisonDepartment of Economicsand CEPRand also NBERpanle.barwick@gmail.com Hongyuan XiaCornell UniversityDepartment of Economicshx276@cornell.edu 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 secondpillar. The rest of the world, by contrast, plays a peripheral role, functioning primarily as consumersof existing medicines or producers of generic copies rather than creators of novel technologies. 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,2018; Garthwaite, 2025). The logic is straightforward. Pharmaceutical R&D entails high uncertaintyand enormous fixed costs, with only 10% of projects ultimately receiving drug approval and a medianPhase III trial costing $21.4 million (Martin et al., 2017; Aryal et al., 2024). For most countries wheremarket size is limited, budgets are constrained, and the technological frontier is distant, catching upto the global innovation frontier seems out of reach. 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 forcesor policy designs contribute to the emergence of a local innovation ecosystem? To answer the first research question, we draw on the Citeline TrialTrove database, a comprehen-sive census of