Journal of Human Resources · 2023 · Hilary Barnes、Alice Chen、Matthew D. McHugh、Michael R. Richards
中文摘要
现有研究考察了《平价医疗法案》(ACA) 医疗补助扩张的需求侧效应，但其供给侧影响尚未得到充分理解。我们构建了一个需求不确定性模型，说明企业如何在固定成本与可变成本的劳动力投资之间进行选择。我们采用双重差分策略，利用医疗补助扩张这一政策变化及超过129,000家医师执业机构的详细人员配置信息，对模型预测进行了实证检验。我们未发现机构在短期内转而雇用成本较低、但雇用本身会产生固定成本的医疗服务提供者类型；相反，扩张后，执业机构雇用任何执业护士或医师助理的可能性降低了4%—8%。这种受抑制的劳动力需求效应似乎主要由小型执业机构所驱动。
Abstract
<h3>Abstract</h3> Existing research has examined the demand-side effects of ACA Medicaid expansions, but supply-side implications are not well-understood. Using a model of uncertain demand, we show how firms choose between fixed- and variable-cost labor investments. We empirically test the model predictions via a difference-in-differences strategy that uses Medicaid expansions and detailed staffing information on over 129,000 physician practices. We find no substitution toward less expensive provider types whose employment carries fixed costs in the short run; instead, practices are 4-8 percent less likely to employ any nurse practitioner or physician assistant post-expansion. Small practices seem to drive the restrained labor demand effects.