The effect of the children's health insurance program on pediatricians' work hours.

Medicare & medicaid research review Pub Date : 2013-04-03 eCollection Date: 2013-01-01 DOI:10.5600/mmrr.003.01.a01

Fang He, Chapin White

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引用次数: 10

Abstract

Objective: Our study examines changes in physicians' work hours in response to a coverage expansion.

Methods: We use as a natural experiment the Children's Health Insurance Program (CHIP), which was established in 1997 and significantly expanded children's eligibility for public health insurance coverage. The magnitude of the CHIP expansion varied across states and over time, allowing its effects to be identified using a state-year fixed effects model. We focus on pediatricians, and we measure their self-reported work hours using multiple waves (pre- and post-CHIP) of the physician survey component of the Community Tracking Study. To address endogeneity concerns, we instrument for CHIP enrollment using key program features (income eligibility cutoffs and waiting times).

Results: We find a large negative relationship between the magnitude of a state's CHIP expansion and trends in pediatricians' work hours. This relationship could be due to key supply-side features of CHIP, including relatively low provider reimbursements and heavy use of managed care tools.

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儿童健康保险计划对儿科医生工作时间的影响。

目的:我们的研究考察了医生的工作时间的变化，以应对覆盖范围的扩大。方法:我们以1997年建立的儿童健康保险计划(CHIP)作为自然实验，该计划显著扩大了儿童享受公共健康保险的资格。CHIP扩张的幅度因州和时间而异，因此可以使用州年固定效应模型来确定其影响。我们关注儿科医生，我们使用社区跟踪研究的医生调查组成部分的多个波(chip前和chip后)来测量他们自我报告的工作时间。为了解决内生性问题，我们使用关键项目特征(收入资格截止日期和等待时间)来衡量CHIP入学率。结果:我们发现一个州的CHIP扩展幅度和儿科医生工作时间的趋势之间存在很大的负相关关系。这种关系可能是由于CHIP的关键供应方特征，包括相对较低的提供者报销和大量使用管理护理工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Medicare & medicaid research review

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