医疗改革与企业动态: 来自 Medicare D 部分和零售药房行业的证据
Health Care Reform and Firm Dynamics: Evidence from Medicare Part D and the Retail Pharmacy Industry
NBER Working Papers · 2026 · [{"name": "Brandyn F. Churchill", "affiliation": []}, {"name": "Georgina Cisneros", "affiliation": []}, {"name": "Kelli R. Marquardt", "affiliation": []}]
中文摘要
医疗改革往往在实际实施之前就已颁布，由此产生的不确定性可能影响企业的决策。我们利用2000—2009年机构层面数据，借助 Medicare Part D 对老年人口占比更高县的影响更大这一事实，考察了该政策对零售药房行业的影响。这一发现与一个概念模型的预测一致：该模型认为实施前的不确定性会抑制新药房进入，而实施后利润率下降则会阻碍其完全恢复。我们发现，Medicare Part D 与药房数量减少5%相关，这一减少主要是由新开业药房减少、而非现有药房关闭增多所致。我们还发现提示性证据表明，药房可及性的降低削弱了 Medicare Part D 在降低死亡率方面的收益。
Abstract
Health care reforms are often enacted before implementation, creating uncertainty that can shape firms’ decisions. We examine how Medicare Part D affected the retail pharmacy industry using 2000-2009 establishment-level data, leveraging the fact that Part D disproportionately affected counties with larger elderly populations. Consistent with predictions from a conceptual model in which pre-implementation uncertainty discourages entry and lower post-implementation margins prevent full recovery, we find that Part D was associated with a 5-percent reduction in pharmacies, driven by fewer openings rather than more closures. We also find suggestive evidence that reduced pharmacy access dampened Part D’s mortality benefits.