How Does Provider Supply and Regulation Influence Health Care Markets? Evidence from Nurse Practitioners and Physician Assistants by Kevin Stange (Journal of Health Economics)
Nurse practitioners (NPs) and physician assistants (PAs) now outnumber family practice doctors in the United States and are the principal providers of primary care to many communities. Recent growth of these professions has occurred amidst considerable cross-state variation in their regulation, with some states permitting autonomous practice and others mandating extensive physician oversight. I find that expanded NP and PA supply has had minimal impact on the office-based healthcare market overall, but utilization has been modestly more responsive to supply increases in states permitting greater autonomy. Results suggest the importance of laws impacting the division of labor, not just its quantity.
Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilization by Hendrik Schmitz (Journal of Health Economics)
This study analyses the effect of a change in the remuneration system for physicians on the treatment lengths as measured by the number of doctor visits using data from the German Socio-Economic Panel over the period 1995-2002. Specifically, I analyse the introduction of a remuneration cap (so called practice budgets) for physicians who treat publicly insured patients in 1997. I find evidence that the reform of 1997 did not change the extensive margin of doctor visits but strongly affected the intensive margin. The conditional number of doctor visits among publicly insured decreased while it increased among privately insured. This can be seen as evidence that physicians respond to the change in incentives induced by the reform by altering their patient mix.
Reference Pricing: Stimulating Cost-Conscious Purchasing and Countering Provider Market Power by James C. Robinson (National Institute for Health Care Management)
The dramatic price variations for common procedures like knee surgeries and colonoscopies have been well documented, as has the fact that these variations generally reflect market power rather than quality. While selection of high-value providers is critical to affordability, consumers often have little incentive to shop around, particularly for costlier services that quickly surpass deductibles. Reference pricing injects new price awareness by setting a maximum payer contribution for a given procedure and leaving the patient responsible for any overage. In this essay, James Robinson lays out evidence that reference pricing has both guided patients to select high-value providers and compelled costlier hospitals to lower their prices to remain competitive.
Effects of Federal Policy to Insure Young Adults: Evidence from the 2010 Affordable Care Act’s Dependent-Coverage Mandate by Yaa Akosa Antwi, Asako S. Moriya and Kosali Simon (American Economic Journal)
Using data from the Survey of Income and Program Participation (SIPP), we study the health insurance and labor market implications of the recent Affordable Care Act (ACA) provision that allows dependents to remain on parental policies until age 26. Our comparison of outcomes for young adults aged 19-25 with those who are older and younger, before and after the law, shows a high take-up of parental coverage, resulting in substantial reductions in uninsurance and other forms of coverage. We also find preliminary evidence of increased labor market flexibility in the form of reduced work hours.
Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service by Martin Gaynor, Rodrigo Moreno-Serra and Carol Propper (American Economic Journal)
The effect of competition on the quality of health care remains a contested issue. Most empirical estimates rely on inference from nonexperimental data. In contrast, this paper exploits a procompetitive policy reform to provide estimates of the impact of competition on hospital outcomes. The English government introduced a policy in 2006 to promote competition between hospitals. Using this policy to implement a difference-in-differences research design, we estimate the impact of the introduction of competition on not only clinical outcomes but also productivity and expenditure. We find that the effect of competition is to save lives without raising costs.
The Optimal Practice of Evidence-Based Medicine: Incorporating Patient Preferences in Practice Guidelines by Victor M. Montori, Juan Pablo Brito, and M. Hassan Murad (JAMA)