公共保险扩张与医师诊所的劳动需求
Public Insurance Expansions and Labor Demand in Physician Practices
Journal of Human Resources · 2023 · [{"name": "Hilary Barnes", "affiliation": ["Widener University"]}, {"name": "Alice Chen", "affiliation": ["State Innovation Exchange"]}, {"name": "Matthew D. McHugh", "affiliation": ["St. Matthew's University"]}, {"name": "Michael R. Richards", "affiliation": ["Baylor University", "St Michael's Hospital"]}]
中文摘要
既有研究考察了《平价医疗法案》（ACA）医疗补助（Medicaid）扩展的需求侧效应，但其供给侧影响尚未得到充分理解。基于一个需求不确定性模型，我们展示了企业如何在固定成本型与可变成本型的劳动投资之间进行选择。我们采用双重差分策略对模型预测进行实证检验，该策略利用医疗补助扩展以及超过 12.9 万家医师诊所的详细人员配置信息。我们没有发现向那些较为廉价、但其雇佣在短期内构成固定成本的服务提供者类型的替代；相反，扩展后，诊所雇用任何执业护士或医师助理的可能性下降了 4%–8%。小型诊所似乎是这一受抑制的劳动需求效应的主要驱动因素。
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.