Working Paper: NBER ID: w26095
Authors: 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.
Keywords: Medicaid; Physician Payments; Patient Access; Health Outcomes
JEL Codes: H51; H75; I13; I14; I18; I24
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Increase in Medicaid payments (I18) | Reduction in reports of adult Medicaid beneficiaries being told that physicians are not accepting new patients (I18) |
| Increase in Medicaid payments (I18) | Reduction in reports of doctors not accepting their insurance (I13) |
| Increase in Medicaid payments (I18) | Decrease in parents reporting difficulties in finding a doctor for their children (I19) |
| Increase in Medicaid payments (I18) | Increase in the probability of beneficiaries visiting a doctor in the past two weeks (I14) |
| Increase in Medicaid payments (I18) | Increase in the likelihood of beneficiaries reporting being in very good or excellent health (I19) |
| Increase in Medicaid payments (I18) | Reduction in chronic absenteeism due to illness among children (I21) |
| Increase in Medicaid payments (I18) | Reduction in overall absenteeism (J22) |
| Increase in Medicaid payments (I18) | Decrease in the probability of being in fair or poor health (I14) |
| Increase in Medicaid payments (I18) | Increase in the likelihood of being in excellent or very good health (I14) |