Public Health Insurance Coverage Expansion and Physicians’ Working Hours

Over the past two decades, there have been two large public health insurance expansions, the State Children’s Health Insurance Program (SCHIP) and the Affordable Care Act (ACA). These insurance programs have significantly increased the number of patients with public health insurance and the demand for medical services, but it is not clear whether providers will supply additional services for newly-insured patients. Because, public health insurance programs provide relatively low reimbursement rates to physicians which discourage physicians to accept publicly-insured patients. This paper focuses on the labor supply response of physicians to these expansions. I use data from the Community Tracking Study (CTS) physician survey (1996-1997, 1998-1999, and 2000-2001) to examine the SCHIP expansion and the 2012-2015 American Community Study (ACS) to examine the ACA expansion. In response to the introduction of SCHIP, my estimates suggest that physicians reallocate their total working hours between patient care and non-patient care activities. The size of the impact was greater in areas with high level of physician concentration prior to the expansion. Physicians in high concentration areas tend to decrease time spent on direct patient care, but increase hours on non-direct patient care. In response to the ACA, physicians’ working hours did not increase, but working hours, the probability of being employed, and the probability of being employed increased for registered nurses. This suggests that physicians might utilize other healthcare providers to accommodate increases in demand for medical services after the expansion.