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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 two-thirds of disparities in access among adults and would eliminate such disparities entirely among children. These improvements in access lead to more office visits, better self-reported health, and reduced school absenteeism. While attention is often focused on the role of demand-side insurance generosity, such as program eligibility and patient cost-sharing, our results demonstrate that financial incentives for physicians drive access to care and have important implications for patient health.

Suggested Citation

  • Diane Alexander & Molly Schnell, 2019. "The Impacts of Physician Payments on Patient Access, Use, and Health," NBER Working Papers 26095, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:26095
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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. 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.
    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. Dominic Coey, 2015. "Physicians' financial incentives and treatment choices in heart attack management," Quantitative Economics, Econometric Society, vol. 6(3), pages 703-748, November.
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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. Abe Dunn & Joshua D. Gottlieb & Adam Shapiro & Daniel J. Sonnenstuhl & Pietro Tebaldi, 2021. "A Denial a Day Keeps the Doctor Away," NBER Working Papers 29010, National Bureau of Economic Research, Inc.
    3. Maggie Shi, 2023. "Monitoring for Waste: Evidence from Medicare Audits," NBER Working Papers 31559, National Bureau of Economic Research, Inc.
    4. 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.
    5. Huitfeldt, Ingrid, 2021. "Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries," Health Policy, Elsevier, vol. 125(6), pages 732-738.
    6. 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).
    7. 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.
    8. 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.
    9. 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).
    10. 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).
    11. 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.
    12. 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.
    13. 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).
    14. 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.
    15. 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.
    16. 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].
    17. 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.
    18. 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).
    19. 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.

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    More about this item

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I24 - Health, Education, and Welfare - - Education - - - Education and Inequality

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