Victor G. Rodwin
1*, Guilhem Fabre
2, Rafael F. Ayoub
31 Robert F. Wagner Graduate School of Public Service, New York University, New York City, NY, USA.
2 Université Paul Valéry Montpellier 3, IRIEC EA 740, Montpellier, France.
3 Wagner School of Public Service, New York University, New York City, NY, USA.
Abstract
BRIC nations – Brazil, Russia, India, and China – represent 40% of the world’s population, including a growing
aging population and middle class with an increasing prevalence of chronic disease. Their healthcare systems
increasingly rely on prescription drugs, but they differ from most other healthcare systems because healthcare
expenditures in BRIC nations have exhibited the highest revenue growth rates for pharmaceutical multinational
corporations (MNCs), Big Pharma. The response of BRIC nations to Big Pharma presents contrasting cases
of how governments manage the tensions posed by rising public expectations and limited resources to satisfy
them. Understanding these tensions represents an emerging area of research and an important challenge for all
those who work in the field of health policy and management (HPAM).