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讲座题目：Affordable Care Act, Physicians' Location Choices, and Care Access Disparity （with Hanming Fang and Wei Shi）

主讲人：林琳

华东师范大学公共管理学院助理教授,经济学博士，毕业于美国俄亥俄州立大学。主要研究领域为健康经济学、社会保障与发展经济学，尤其聚焦医疗卫生改革、弱势群体社会保障及其他发展议题。已发表论文见于Social Science & Medicine -Population Health, Journal of the Economics of Ageing。

讲座时间：2024年11月25日（周一）14:00

讲座地点：金融学院116教室

内容摘要

The implementation of the Affordable Care Act (ACA) has led to significant increases in health insurance enrollment among low- and moderate-income populations, particularly in disadvantaged areas. Exploiting geographic variations in ACA-induced enrollment changes, we use a dyadic regression model to estimate whether, and to what extent, health insurance enrollment gains—especially in terms of private insurance and Medicaid—affect physicians’ location choices and, consequently, reshape spatial disparities in physician access. We find that an increase in private insurance enrollment in a location attracts physicians through relo cation, whereas an increase in Medicaid enrollment tends to deter them, particularly among those with greater experience or from top-tier medical programs. The discouraging effect of Medicaid is largely due to its low reimbursement rates, while the appeal of private insurance is driven by physicians’ desire to serve a broader patient market. In sum, our simulations, based on reduced-form estimates and a discrete choice model, suggest that ACA-driven insurance ex pansions may have inadvertently exacerbated disparities in physician access in disadvantaged areas. Regarding other medical providers, we find that the ACA health insurance expansion similarly influences the geographic distribution of physician assistants and nurses, but has no significant effect on medical institutions such as physician organizations, hospitals, and health centers.