University of Southern California, School of Pharmacy, Sol Price School of Public Policy, and Leonard D. Schaeffer Center for Health Policy and Economics, 635 Downey Way, Los Angeles, CA 90089-3333, United States.
University of Southern California, School of Pharmacy, Sol Price School of Public Policy, and Leonard D. Schaeffer Center for Health Policy and Economics, 635 Downey Way, Los Angeles, CA 90089-3333, United States; University of Southern California, School of Pharmacy; and National Bureau of Economic Research (NBER), United States.
J Health Econ. 2019 Mar;64:43-54. doi: 10.1016/j.jhealeco.2019.02.001. Epub 2019 Feb 10.
A longstanding literature explores how altruism affects the way physicians respond to incentives and provide care. We analyze how patient socioeconomic status mediates these responses. We show theoretically that patient socioeconomic status systematically influences the way physicians respond to reimbursement changes, and we identify the channels through which these effects operate. We use two Medicare reimbursement changes to investigate these insights empirically. We confirm that a given physician facing an increase in reimbursement boosts utilization by more when treating richer patients. We show that average supply price elasticities vary from 0.02 to 0.18 for a given physician, depending on the patient's socioeconomic status. Finally, we show that the Medicare reforms we study led to overall reimbursement increases that raised healthcare utilization by 10% more for high-income patients compared to their low-income peers.
长期以来，文献一直在探讨利他主义如何影响医生对激励措施的反应以及提供医疗服务的方式。我们分析了患者社会经济地位如何调节这些反应。我们从理论上表明，患者社会经济地位系统地影响医生对报销变化的反应方式，并且我们确定了这些影响的作用渠道。我们使用两项医疗保险报销变化来实证研究这些观点。我们证实，面对报销增加的给定医生在治疗富裕患者时会增加更多的利用率。我们表明，对于给定的医生，平均供应价格弹性从 0.02 到 0.18 不等，具体取决于患者的社会经济地位。最后，我们表明，我们研究的医疗保险改革导致总体报销增加，与低收入患者相比，高收入患者的医疗保健利用率增加了 10%。
