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实践中的公共与私人选择:军队医疗卫生系统

Public and Private Options in Practice: The Military Health System
American Economic Journal: Economic Policy · 2023 · Michael Frakes、Jonathan Gruber、Timothy Justicz

中文摘要

近期有关医疗改革的讨论,包括围绕军队医疗卫生系统(MHS)与退伍军人事务管理局展开的讨论,凸显了医疗服务应由公共部门还是私人部门提供的争议。本文使用军队医疗卫生系统中分娩理赔的新数据,并结合具有合理外生性的患者迁移与各基地在是否设有基地医院方面的异质性,识别了在军事基地内相对于基地外接受产科护理的影响。研究发现,基地外护理的资源使用强度略高,但结果也明显更好,这表明医疗服务私有化带来了边际效率增益。

Abstract

Recent debates over health care reform, including in the context of the Military Health System (MHS) and Veterans Administration, highlight the dispute between public and private provision of health care services. Using novel data on childbirth claims from the MHS and drawing on the combination of plausibly exogenous patient moves and heterogeneity across bases in the availability of base hospitals, we identify the impact of receiving obstetrical care on versus off military bases. We find evidence that off-base care is associated with slightly greater resource intensity, but also notably better outcomes, suggesting marginal efficiency gains from care privatization.
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