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The Impacts of Physician Payments on Patient Access, Use, and Health

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  • Diane Alexander
  • Molly Schnell

Abstract

We examine how supply-side health insurance generosity affects patient access, use, and health. Exploiting large, exogenous changes in Medicaid reimbursement rates for physicians, we find that increasing payments for new patient office visits reduces reports of providers turning away beneficiaries: closing the gap in payments between Medicaid and private insurers would reduce more than half of disparities in access among adults and would eliminate such disparities among children. We further find that higher physician reimbursement leads to more office visits, better self-reported health, and reduced school absenteeism among the program's beneficiaries.

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  • Diane Alexander & Molly Schnell, 2024. "The Impacts of Physician Payments on Patient Access, Use, and Health," American Economic Journal: Applied Economics, American Economic Association, vol. 16(3), pages 142-177, July.
  • Handle: RePEc:aea:aejapp:v:16:y:2024:i:3:p:142-77
    DOI: 10.1257/app.20210227
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    References listed on IDEAS

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    1. Laurence C. Baker & Anne Beeson Royalty, 2000. "Medicaid Policy, Physician Behavior, and Health Care for the Low-Income Population," Journal of Human Resources, University of Wisconsin Press, vol. 35(3), pages 480-502.
    2. Dominic Coey, 2015. "Physicians' financial incentives and treatment choices in heart attack management," Quantitative Economics, Econometric Society, vol. 6(3), pages 703-748, November.
    3. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    4. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
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    Cited by:

    1. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Neighborhoods, networks, and delivery methods," Journal of Health Economics, Elsevier, vol. 80(C).
    2. Dillender, Marcus & Friedson, Andrew & Gian, Cong & Simon, Kosali, 2019. "Does the healthcare educational market respond to short-run local demand?," Economics of Education Review, Elsevier, vol. 73(C).
    3. Cadena, Brian C. & Smith, Austin C., 2022. "Performance pay, productivity, and strategic opt-out: Evidence from a community health center," Journal of Public Economics, Elsevier, vol. 206(C).
    4. Staiger, Becky, 2022. "Disruptions to the patient-provider relationship and patient utilization and outcomes: Evidence from medicaid managed care," Journal of Health Economics, Elsevier, vol. 81(C).
    5. Dillender, Marcus & Jinks, Lu & Lo Sasso, Anthony T., 2023. "When (and why) providers do not respond to changes in reimbursement rates," Journal of Public Economics, Elsevier, vol. 217(C).
    6. Devlin, Aileen M. & McCormack, Grace, 2023. "Physician responses to Medicare reimbursement rates," Journal of Health Economics, Elsevier, vol. 92(C).
    7. Dauth, Christine, 2021. "The effects of private versus public health insurance on health and labor market outcomes," IAB-Discussion Paper 202103, Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany].
    8. Joseph J. Doyle Jr. & Becky Staiger, 2021. "Physician Group Influences on Treatment Intensity and Health: Evidence from Physician Switchers," NBER Working Papers 29613, National Bureau of Economic Research, Inc.
    9. Kara Contreary & Katharine Bradley & Matthew Niedzwiecki & Kristin Maurer & Sandra Chao & Brenda Natzke & Maggie Samra, "undated". "Section 1115 Alternative Medicaid Expansions: Summative Evaluation Report," Mathematica Policy Research Reports 042b5fe43da44afea9538552b, Mathematica Policy Research.
    10. Jeffrey P. Clemens & Jonathan M. Leganza & Alex Masucci, 2021. "Plugging Gaps in Payment Systems: Evidence from the Take-Up of New Medicare Billing Codes," CESifo Working Paper Series 9209, CESifo.
    11. Maggie Shi, 2023. "Monitoring for Waste: Evidence from Medicare Audits," NBER Working Papers 31559, National Bureau of Economic Research, Inc.
    12. Shooshan Danagoulian & Daniel Grossman & David Slusky, 2022. "Health Care Following Environmental Disasters: Evidence from Flint," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 41(4), pages 1060-1089, September.
    13. Abe Dunn & Joshua D Gottlieb & Adam Hale Shapiro & Daniel J Sonnenstuhl & Pietro Tebaldi, 2024. "A Denial a Day Keeps the Doctor Away," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 139(1), pages 187-233.
    14. Pinka Chatterji & Sandra L. Decker & Jason Huh, 2022. "Medicaid physician fees and access to care among children with special health care needs," Review of Economics of the Household, Springer, vol. 20(3), pages 887-919, September.
    15. Jie Ma & Kosali Simon, 2021. "Heterogeneous effects of health insurance on birth related outcomes: Unpacking compositional versus direct changes," Contemporary Economic Policy, Western Economic Association International, vol. 39(3), pages 626-640, July.
    16. Huitfeldt, Ingrid, 2021. "Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries," Health Policy, Elsevier, vol. 125(6), pages 732-738.
    17. Jie Ma & Kosali I. Simon, 2020. "Heterogeneous Effects Of Health Insurance On Birth Related Outcomes: Unpacking Compositional Vs. Direct Changes," NBER Working Papers 27728, National Bureau of Economic Research, Inc.
    18. Brigitte Dormont & Cécile Gayet, 2021. "The Ban on Extra-Fees for Beneficiaries of the CMU-C Health Cover: What Consequences for Physicians and Dentists in Private Practice?," Economie et Statistique / Economics and Statistics, Institut National de la Statistique et des Etudes Economiques (INSEE), issue 524-525, pages 31-47.
    19. Joshua D. Gottlieb & Maria Polyakova & Kevin Rinz & Hugh Shiplett & Victoria Udalova, 2020. "Who Values Human Capitalists' Human Capital? Healthcare Spending and Physician Earnings," Working Papers 20-23, Center for Economic Studies, U.S. Census Bureau.
    20. Calvin Ackley & Abe Dunn & Eli Liebman & Adam Hale Shapiro, 2024. "Are Medicaid and Medicare Patients Treated Equally?," Working Paper Series 2024-14, Federal Reserve Bank of San Francisco.
    21. Cadena, Brian C. & Smith, Austin C., 2019. "Performance Pay and Productivity in Health Care: Evidence from Community Health Centers," IZA Discussion Papers 12586, Institute of Labor Economics (IZA).

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    More about this item

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • J44 - Labor and Demographic Economics - - Particular Labor Markets - - - Professional Labor Markets and Occupations

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