Physician Fees and Procedure Intensity: the Case of Cesarean Delivery

27 Pages Posted: 17 Dec 1998 Last revised: 7 Dec 2022

See all articles by Jonathan Gruber

Jonathan Gruber

Massachusetts Institute of Technology (MIT) - Department of Economics; National Bureau of Economic Research (NBER)

John Kim

Massachusetts Institute of Technology (MIT)

Dina Mayzlin

University of Southern California - Marshall School of Business

Date Written: October 1998

Abstract

While there is a large literature investigating the response of treatment intensity to Medicare reimbursement differentials, there is much less work on this question for the Medicaid program. The answers for Medicare may not apply in the Medicaid context, since a smaller share of physician's patients will be Medicaid insured, so that income effects from fee changes may be dominated by substitution effects. We investigate the effect of Medicaid fee differentials on the use of cesarean delivery over the 1988-1992 period. We find, in contrast to the backward-bending supply curve implied by the Medicare literature larger fee differentials between cesarean and normal childbirth for the Medicaid program leads to higher cesarean delivery rates. In particular, we find that the lower fee differentials between cesarean and normal childbirth under the Medicaid program than under private insurance can explain between one-half and three-quarters of the difference between Medicaid and private cesarean delivery rates. Our results suggest that Medicaid reimbursement reductions can cause real reductions in the intensity with which Medicaid patients are treated.

Suggested Citation

Gruber, Jonathan and Kim, John and Mayzlin, Dina, Physician Fees and Procedure Intensity: the Case of Cesarean Delivery (October 1998). NBER Working Paper No. w6744, Available at SSRN: https://ssrn.com/abstract=133648

Jonathan Gruber

Massachusetts Institute of Technology (MIT) - Department of Economics ( email )

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National Bureau of Economic Research (NBER)

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John Kim

Massachusetts Institute of Technology (MIT) ( email )

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United States

Dina Mayzlin

University of Southern California - Marshall School of Business ( email )

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Los Angeles, CA California 90089
United States
213-740-3360 (Phone)

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