Econ Papers Daily / 期刊论文
医疗保健中的地域差异：来自美国军事卫生系统强制迁移者的证据
Place-Based Variation in Health Care: Evidence from Mandatory Movers in the U.S. Military Health System
摘要
There is increasing evidence on regional variations in US Medicare health care utilization based on older patients who move. Yet moving for the elderly population is typically endogenous, and evidence is limited for younger populations. In this paper, we harness the mandatory migration of military personnel to estimate supply and demand factors in a system of care for younger enrollees in which military physicians are salaried and copayments and deductibles are negligible. Our preferred estimates imply that supply effects explain between one-half and two-thirds of overall regional variation. These variations cannot be explained by differences in quality of care, but appear consistent with location-specific differences in physician beliefs. We are grateful for financial support from the Department of Defense (DoD) (Award HT94022210005) and for very helpful comments from Amy Finkelstein, Robert Kaestner, Edward Norton, two anonymous reviewers, and the editor. The contents, views or opinions expressed in this publication or presentation are those of the author(s) and do not necessarily reflect official policy or position of Uniformed Services University of the Health Sciences, the DoD, or Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.
中文摘要
越来越多基于老年迁移人群的证据表明，美国Medicare医疗利用存在地区差异。然而，老年人口的迁移通常是内生的，且针对较年轻人群的证据仍然有限。本文利用军人强制性迁移，在一个面向较年轻参保者的医疗体系中估计供给与需求因素，该体系中军医领取固定工资，共付额和免赔额可忽略不计。我们偏好的估计结果表明，供给效应可解释总体地区差异的二分之一至三分之二。这些差异无法由医疗质量差异解释，但与医生信念的地域性差异相一致。我们感谢美国国防部（DoD）提供的资助（项目编号HT94022210005），并感谢Amy Finkelstein、Robert Kaestner、Edward Norton、两位匿名审稿人以及编辑提出的非常有帮助的意见。本出版物或报告中表达的内容、观点或意见仅代表作者本人，不一定反映健康科学制服服务大学、国防部或陆军、海军、空军部的官方政策或立场。提及商品名称、商业产品或组织并不意味着美国政府对其的认可。