The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions
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.
I am grateful for the helpful comments on this draft from Jen Brown, Meghan Busse, Kerwin Charles, Leemore Dafny, David Dranove, Mark Duggan, and Bill Evans as well as seminar participations at the Olin Business School at Washington University, the Harris School of Public Policy at the University of Chicago, and the Indiana University School of Policy and Environmental Affairs. In addition, I am thankful to Kosali Simon for providing valuable data and suggestions on the entire project. All errors remain my own. The views expressed herein are those of the author and do not necessarily reflect the views of the National Bureau of Economic Research.