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The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions

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  • Craig L. Garthwaite
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    Abstract

    In the United States, public health insurance programs cover over 90 million individuals. Changes in the scope of these programs, such as the Medicaid expansions under the recently passed Patient Protection and Affordable Care Act, may have large effects on physician behavior. This study finds that following the implementation of the State Children’s Health Insurance Program, physicians decreased the number of hours spent with patients, but increased their participation in the expanded program. Suggestive evidence is found that this decrease in hours was a result of shorter office visits. These findings are consistent with the predictions from a mixed-economy model of physician behavior with public and private payers and also provide evidence of crowd out resulting from the creation of SCHIP.

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    Bibliographic Info

    Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 17070.

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    Date of creation: May 2011
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    Publication status: published as Garthwaite, Craig. 2012. The Doctor Might See You Now: The Supply Side of Public Health Insurance Expansions. American Economic Journal: Economic Policy. 4(3): 190-217.
    Handle: RePEc:nbr:nberwo:17070

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    1. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, Elsevier, vol. 23(5), pages 1059-1082, September.
    2. Gruber, Jonathan & Simon, Kosali, 2008. "Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance?," Journal of Health Economics, Elsevier, Elsevier, vol. 27(2), pages 201-217, March.
    3. Jonathan Gruber & Kathleen Adams & Joseph P. Newhouse, 1997. "Physician Fee Policy and Medicaid Program Costs," NBER Working Papers 6087, National Bureau of Economic Research, Inc.
    4. Dranove, David & Wehner, Paul, 1994. "Physician-induced demand for childbirths," Journal of Health Economics, Elsevier, Elsevier, vol. 13(1), pages 61-73, March.
    5. 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.
    6. Ham, John C. & Shore-Sheppard, Lara, 2005. "The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP," Journal of Public Economics, Elsevier, Elsevier, vol. 89(1), pages 57-83, January.
    7. Dranove, David, 1988. "Demand Inducement and the Physician/Patient Relationship," Economic Inquiry, Western Economic Association International, Western Economic Association International, vol. 26(2), pages 281-98, April.
    8. Gruber, Jon & Kim, John & Mayzlin, Dina, 1999. "Physician fees and procedure intensity: the case of cesarean delivery," Journal of Health Economics, Elsevier, Elsevier, vol. 18(4), pages 473-490, August.
    9. Blumberg, Linda J. & Dubay, Lisa & Norton, Stephen A., 2000. "Did the Medicaid expansions for children displace private insurance? An analysis using the SIPP," Journal of Health Economics, Elsevier, Elsevier, vol. 19(1), pages 33-60, January.
    10. David Card & Lara D. Shore-Sheppard, 2002. "Using Discontinuous Eligibility Rules to Identify the Effects of the Federal Medicaid Expansions on Low Income Children," NBER Working Papers 9058, National Bureau of Economic Research, Inc.
    11. Cromwell, Jerry & Mitchell, Janet B., 1986. "Physician-induced demand for surgery," Journal of Health Economics, Elsevier, Elsevier, vol. 5(4), pages 293-313, December.
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    Cited by:
    1. Seth Freedman & Haizhen Lin & Kosali Simon, 2014. "Public Health Insurance Expansions and Hospital Technology Adoption," NBER Working Papers 20159, National Bureau of Economic Research, Inc.
    2. Koch, Thomas G., 2013. "Using RD design to understand heterogeneity in health insurance crowd-out," Journal of Health Economics, Elsevier, Elsevier, vol. 32(3), pages 599-611.

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