The Impact of Physician Supply on the Healthcare System: Evidence from Japan's New Residency Program
The Impact of Physician Supply on the Healthcare System: Evidence from Japan's New Residency Program
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DOI：
10.1002/hec.3229
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发表时间：
2016-11-01
期刊：
影响因子：
2.1
通讯作者：
Watanabe, Yasutora
中科院分区：
文献类型：
--
作者：
Iizuka, Toshiaki;Watanabe, Yasutora
使用2004年日本自然实验影响医生供应，我们研究医生劳动力市场及其对医院退出和健康结果的影响。虽然医生在确定医疗保健系统的性能发挥了核心作用，确定他们的影响是困难的，因为医生的供应是内生决定的。我们规避这个问题，利用一个外源性的冲击，医生供应所创造的引入一个新的住院医生计划-我们的自然实验。基于覆盖日本所有医生的面板数据，我们发现，引入新的住院医师计划大大减少了一些农村市场的医生供应，当地医院依赖于大学医院填补医生职位。我们还发现，医生市场的工资增加，在受影响的市场相对于受影响较小的市场。最后，我们发现，医生市场工资的这种变化迫使医院退出受影响的市场，并对这些市场的患者健康结果产生负面影响。医疗保健市场受到严格的价格管制，这一事实可能会加剧这些影响。版权所有（c）2015约翰威利父子有限公司
Using a 2004 Japanese natural experiment affecting physician supply, we study the physician labor market and its effects on hospital exits and health outcomes. Although physicians play a central role in determining the performance of a healthcare system, identifying their impacts are difficult because physician supply is endogenously determined. We circumvent the problem by exploiting an exogenous shock to physician supply created by the introduction of a new residency program - our natural experiment. Based on panel data covering all physicians in Japan, we find that the introduction of a new residency program substantially decreased the supply of physicians in some rural markets where local hospitals had relied on university hospitals for filling physician positions. We also find that physician market wages increased in the affected markets relative to less affected markets. Finally, we find that this change in physician market wages forced hospitals to exit affected markets and negatively affected patient health outcomes in those markets. These effects may be exacerbated by the fact that the healthcare market was rigidly price-regulated. Copyright (c) 2015 John Wiley & Sons, Ltd.