Managed care, health expenditures, and physician incomes: Three essays on health economics.

摘要

The first two chapters of this dissertation examine the competitive effects of Health Maintenance Organizations (HMOs) on health care costs and physician prices. Chapter one investigates the effect of managed care on both fee-for-service (FFS) and overall health care expenditures using data from the Medicare program. Fixed effects models and two-stage least squares are employed. Results indicate that increases in managed care were associated with declines in Medicare expenditures during the late 1980s. Separate analysis of hospital and supplementary insurance expenditures shows that managed care reduced overall and FFS expenditures in both hospital and ambulatory settings.; To further examine the findings of chapter one, chapter two develops 1990 county-level estimates of overall HMO enrollment and market share for all counties in the United States. The estimates are constructed from data on the total enrollment and market area of all HMOs in the country. Enrollees are distributed to counties using three different methods. The new estimates are applied to examine the relationship between HMO market share and the fee for a normal office visit with an established patient charged by 2,845 young FFS physicians. Using two-stage least squares, I find that increases of 10 percentage points in HMO market share are associated with decreases of 10.7 percent in fees. However, two-stage least squares analysis of physician incomes did not reveal a significant association.; Switching gears, the third chapter examines the difference between the earnings of male and female physicians. Analysis of 1990 earnings shows that the gender gap has fallen considerably since the early 1980s. By one estimate the entire gap can now be explained by differences in endowments. In some specialties and settings, women earn more than men after correcting for endowments. Analysis of cohorts of physicians new to practice in 1986 and 1990 shows that the earnings of new female physicians grew faster than the earnings of their male counterparts. In a longitudinal sample, the earnings of practicing female physicians grew faster than the earnings of males in several specialties and settings between 1986 and 1990.