TY - JOUR AU - Currie,Janet AU - Gruber,Jonathan AU - Fischer,Michael TI - Physician Payments and Infant Mortality: Evidence from Medicaid Fee Policy JF - National Bureau of Economic Research Working Paper Series VL - No. 4930 PY - 1994 Y2 - November 1994 UR - http://www.nber.org/papers/w4930 L1 - http://www.nber.org/papers/w4930.pdf N1 - Author contact info: Janet Currie Princeton University 316 Wallace Hall Princeton, NJ 08544 Tel: 609-258-7393 Fax: 609-258-5974 E-Mail: jcurrie@princeton.edu Jonathan Gruber MIT Department of Economics E52-355 50 Memorial Drive Cambridge, MA 02142-1347 Tel: 617/253-8892 Fax: 617/253-1330 E-Mail: gruberj@mit.edu Michael Fischer Division of Pharmacoepidemiology and Pharmacoecono Brigham & Women's Hospital/ Harvard Medical School 1620 Tremont Street, suite 3030 Boston, MA 02120 Tel: 617-278-0927 Fax: 617-232-8602 E-Mail: mfischer@partners.org AB - While efforts to improve the health of the uninsured have focused on demand side policies such as increasing insurance coverage, supply side changes may be equally important. Yet there is little direct evidence on the effect of policies designed to increase the supply of Medicaid services to the poor. We provide such evidence by examining the relationship between infant mortality and the ratio of Medicaid fees to private fees for obstetrician/gynecologists. We build a state and year specific index of the fee ratio for 1979-1992, a period of substantial variation in relative Medicaid fees. We find that increases in fee ratios are associated with significant declines in the infant mortality rate. We also find that higher fees raise payments made to physicians and clinics under the Medicaid program, but reduce payments to hospitals. Finally, we compare the cost effectiveness of reducing infant mortality by increasing fee ratios to the efficacy of reducing mortality by expanding the Medicaid eligibility of pregnant women. Although our results are sensitive to the time period used, we conclude that raising fee ratios is at least as cost effective as increasing eligibility. ER -