DOI

10.17077/etd.x6m8f9ny

Document Type

Dissertation

Date of Degree

Summer 2018

Degree Name

PhD (Doctor of Philosophy)

Degree In

Economics

First Advisor

Frisvold, David

First Committee Member

Shane, Dan

Second Committee Member

Garlick, Julia

Third Committee Member

Ayyagari, Padmaja

Fourth Committee Member

Song, Suyong

Abstract

This thesis focuses on how health care policies affect the labor supply of physicians and beneficiaries. Further, I examine how the labor supply responses of physicians vary based on the level of competition.

In the first chapter, I focus on the labor supply response of physicians to two large public health insurance expansions, the State Children’s Health Insurance Program (SCHIP) and the Affordable Care Act (ACA). These insurance programs have significantly increased the number of patients with public health insurance and the demand for medical services, but it is not clear whether providers will supply additional services for newly-insured patients. In response to the introduction of SCHIP, my estimates suggest that physicians reallocate their total working hours between patient care and non-patient care activities. The size of the impact was greater in areas with high level of physician concentration prior to the expansion. Physicians in high concentration areas tend to decrease time spent on direct patient care, but increase hours on non-direct patient care. In response to the ACA, physicians’ working hours did not increase, but working hours and the probability of being employed increased for registered nurses. This suggests that physicians might utilize other healthcare providers to accommodate increases in demand for medical services after the expansion.

In the second chapter, we analyzed the impact of expanding Medicaid on health insurance coverage and labor market outcomes. Expansions of public health insurance have the potential to reduce the uninsured rate, but also to reduce coverage through employer-sponsored insurance (ESI), reduce labor supply, and increase job mobility. In January 2014, twenty-five states expanded Medicaid as part of the Affordable Care Act to low-income parents and childless adults. We compare the changes in insurance coverage and labor market outcomes over time of adults in states that expanded Medicaid and in states that did not. Our estimates suggest that the recent expansion significantly increased Medicaid coverage with little decrease in ESI. Overall, the expansion did not impact labor market outcomes, including labor force participation, employment, and hours worked.

In the third chapter, I examined the impact of competition among dentists on the labor supply of dentists. I focus on how dentists’ working hours will changes when the level of competition increases by examining the effect of the National Health Service Corps (NHSC). The NHSC was created to increase the supply of rural physicians, which might increase the competition in rural areas. I examine the number of dentists (extensive margins of labor supply) and the change in the working hours of dentists (intensive margins of labor supply) in response to the increased level of physician competition. I found that 1 percent increase in NHSC-approved sites increases 5.4% increases in the number of providers and 0.2% of competition in a rural county. In addition, I found that there is a positive relationship between the number of NHSC-approved sites and providers’ working hours. If the competition among dentists increases about 1, then working hours of providers increase about 6 hours per week.

Keywords

Health Economics, Health Policy, Labor Economics

Pages

xiii, 113 pages

Bibliography

Includes bibliographical references (pages 108-113).

Copyright

Copyright © 2018 Youn Soo Jung

Included in

Economics Commons

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