Place-based variation in health care: evidence from mandatory movers in the U.S. military health system
Journal of Health Economics · 2026 · Roxana Leal、Wei Luan、Jonathan Skinner、John Zhou
中文摘要
基于老年迁移人群的证据，关于美国 Medicare 医疗服务利用地区差异的研究日益增多。然而，老年人口的迁移通常是内生的，且针对较年轻人群的证据仍然有限。本文利用军人的强制性迁移，估计一个面向较年轻参保者的医疗保健体系中的供给与需求因素；在该体系中，军医领取固定薪金，共付额和免赔额可忽略不计。我们的首选估计表明，供给效应可解释整体地区差异的二分之一至三分之二。这些差异无法由医疗质量差异来解释，但与医生信念的地域性差异相一致。我们感谢美国国防部（DoD）的资助（项目编号 HT94022210005），并感谢 Amy Finkelstein、Robert Kaestner、Edward Norton、两位匿名审稿人以及编辑提出的极具帮助的意见。本出版物或报告中表达的内容、观点或意见仅代表作者本人，不一定反映健康科学统一服务大学、美国国防部或陆军、海军、空军各部门的官方政策或立场。提及商品名称、商业产品或组织并不意味着美国政府的认可。
Abstract
There is increasing evidence on regional variations in US Medicare health care utilization based on older patients who move. Yet moving for the elderly population is typically endogenous, and evidence is limited for younger populations. In this paper, we harness the mandatory migration of military personnel to estimate supply and demand factors in a system of care for younger enrollees in which military physicians are salaried and copayments and deductibles are negligible. Our preferred estimates imply that supply effects explain between one-half and two-thirds of overall regional variation. These variations cannot be explained by differences in quality of care, but appear consistent with location-specific differences in physician beliefs. We are grateful for financial support from the Department of Defense (DoD) (Award HT94022210005) and for very helpful comments from Amy Finkelstein, Robert Kaestner, Edward Norton, two anonymous reviewers, and the editor. The contents, views or opinions expressed in this publication or presentation are those of the author(s) and do not necessarily reflect official policy or position of Uniformed Services University of the Health Sciences, the DoD, or Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.