Doctoral Dissertation Research: The Impact of Managed Care on the Gender Gap Among Physicians

从20世纪70年代开始，管理式医疗的出现和传播显著加剧了医疗保健行业的产品市场竞争。与此同时，在过去20年里，女性医生的相对收入也取得了显著的增长。这两个趋势可能有什么关联呢？经济理论预测，产品市场竞争的加剧使得消费者、同事和雇主歧视的成本更高。随着管理式保健的出现和普及，医疗服务市场上的竞争加剧，预计将导致妇女等受歧视群体的相对收入有所改善。这篇论文通过比较管理医疗增长高的州和管理医疗增长低的州的女医生和男医生的收入变化来检验这一理论。初步调查结果表明，与管理保健增长率低的州的女医生相比，1986年至1990年期间，管理保健增长率高的州的女医生每小时收入的性别差距缩小了10个百分点。这几乎消除了时薪上的性别差距，并将年收入差距缩小了约三分之一。初步调查结果只是医疗服务市场变化如何影响医生性别差距的一个快照。为了充分详细地探讨这一主题，该项目利用了大量样本的数据：美国医学会自1981年以来每年收集的专有数据。美国医学会的数据使人们能够跟踪医生人口的供应和地理分布，跟踪医生在医疗服务市场面临的一般趋势，并注意到资源利用和执业安排的重要变化。简而言之，美国医学会的数据将使首席研究人员能够利用不太合适的数据来源建立已经产生的初步结果。

The advent and spread of managed care, beginning in the 1970s, has significantly increased product market competition in the health care industry. At the same time, the gains in relative earnings of female physicians over the last two decades have been remarkable. How might these two trends be related? Economic theory predicts that increased competition in the product market makes it more costly for consumers, colleagues, and employers to discriminate. Increased competition in the market for medical services, associated with the advent and spread of managed care, would be expected to lead to improvements in the relative earnings of discriminated groups such as women. This dissertation research examines this theory by comparing the change in earnings of women physicians to that of male physicians in states with high managed care growth to that in states with low managed care growth. Preliminary findings indicate that women physicians in states with high managed care growth narrowed the gender gap in hourly earnings by ten percentage points between 1986 and 1990 relative to women physicians in low managed care growth states. This nearly eliminates the gender gap in hourly earnings and reduces the gap in annual earnings by about a third. The preliminary findings yield only a snapshot of how changes in the market for medical services affect the gender gap among physicians. To sufficiently explore this topic in detail, this project utilizes data on a large sample: proprietary data collected by the American Medical Association on an annual basis since 1981. The AMA data allows one to track the supply and geographic distribution of the physician population, follow general trends that physicians face in the market for medical services, and note important changes in resource utilization and practice arrangements. In short, the AMA data will allow the principal investigator to build on the preliminary results already generated using less suitable sources of data.