医保支付对低收入个体医疗利用的影响：来自医疗照顾和医疗补助的证据
The Impact of Provider Payments on Health Care Utilization of Low-Income Individuals: Evidence from Medicare and Medicaid
American Economic Journal: Economic Policy · 2025 · [{"name": "Marika Cabral", "affiliation": ["National Bureau of Economic Research"]}, {"name": "Colleen Carey", "affiliation": ["National Bureau of Economic Research", "Cornell University"]}, {"name": "Sarah Miller", "affiliation": ["National Bureau of Economic Research", "Ross School"]}]
中文摘要
在许多覆盖低收入人群的健康保险项目中，服务提供者支付是保险慷慨程度的关键决定因素。本文分析了一项由联邦强制实施的大规模提供者支付提高政策，该政策针对向低收入老年人和残疾人提供的初级保健服务。利用全面的行政数据，我们在双重差分和三重差分研究设计中，利用政策引致的支付提高在受益人和提供者之间的变异。我们发现，支付提高使符合条件受益人的目标服务增加了6%，意味着支付弹性为1.2，并使一年内没有初级保健就诊的低收入受益人比例下降了9%。（JEL G22, I11, I13, I18, I38）
Abstract
Provider payments are the key determinant of insurance generosity within many health insurance programs covering low-income populations. This paper analyzes a large, federally mandated provider payment increase for primary care services provided to low-income elderly and disabled individuals. Using comprehensive administrative data, we leverage variation across beneficiaries and providers in the policy-induced payment increase in difference-in-differences and triple differences research designs. We find the payment increase led to a 6 percent increase in the targeted services for eligible beneficiaries, implying a payment elasticity of 1.2, and decreased the fraction of low-income beneficiaries with no primary care visit in a year by 9 percent. (JEL G22, I11, I13, I18, I38)