Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians.
Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians.
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DOI：
10.1097/mlr.0000000000001740
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发表时间：
2022-08-01
期刊：
影响因子：
3
通讯作者：
Yu, Hao
中科院分区：
文献类型：
--
作者：
Ma, Yanlei;Armstrong, David;Forte, Gaetano J.;Yu, Hao
关键词：
有据可查的是，《平价医疗法案》医疗补助计划的扩展提高了低收入美国人的医疗保健利用率。新兴研究还发现，扩张改变了新医生的地理分布。然而，扩张对医生薪酬的影响尚未研究。我们的目的是评估医疗补助扩张如何影响新初级保健医生 (PCP) 的薪酬，以及这种影响是否因专业、性别和地理位置而异。我们使用准实验双重差分设计来评估医疗补助扩大之前和之后，与未扩大医疗补助的州相比，新 PCP 的薪酬变化。我们的研究包括 2,003 名新 PCP，他们对 2009 年至 2018 年间在纽约完成培训的居民调查做出了回应。我们的主要结果是受访者自我报告的第一年执业起薪。我们的次要结果是受访者自我报告的额外预期收入以及他们因接受工作机会而获得的激励。我们发现，在扩张州，新 PCP（尤其是新普通内科医生和家庭医生）的起薪增长速度快于非扩张州。此外，我们发现，作为在农村地区执业的新 PCP 的补偿方案的一部分，这种扩张与获得额外预期收入的统计显着增加有关。
It is well-documented that the Affordable Care Act Medicaid expansion increased health care utilization by low-income Americans. Emerging studies also found that the expansion changed the geographical distribution of new physicians. However, the effect of the expansion on physician compensation has not been studied. We aimed to assess how the Medicaid expansion affected the compensation of new primary care physicians (PCPs) and whether the effect differed by specialty, gender, and geography. We used a quasi-experimental difference-in-differences design to assess changes in compensation for new PCPs from before to after the Medicaid expansion in states that expanded Medicaid compared to states that did not expand. Our study included 2,003 new PCPs who responded to the Survey of Residents Completing Training in New York between 2009 and 2018. Our primary outcome was respondents’ self-reported starting salary for their first year of practice. Our secondary outcomes were respondents’ self-reported additional anticipated income and incentives they received for accepting the job offer. We found that starting salaries for new PCPs, especially new general internists and family physicians, grew faster in expansion states than in nonexpansion states. In addition, we found that the expansion was associated with a statistically significant increase in receiving additional anticipated income as part of the compensation package for new PCPs practicing in rural areas.