UC San Diego

Each chapter in this dissertation studies how various aspects of U.S. health policy affect physician behavior. The first two chapters study the introduction and effects of new billing codes for primary care services, and the third chapter studies a program that incentivizes physicians to practice in areas with few physicians.

Chapter 1 studies the take-up of new billing codes introduced by Medicare to compensate physicians for important and underprovided types of primary care: Transitional Care and Chronic Care. We identify significant variation in take-up by geography and by physician type. These patterns provide insight into the processes that determine new code take-up rates. We also find take-up patterns by group size and group type that fit with basic economic intuition regarding the investments needed to adopt new billing codes.

Chapter 2 studies the extent to which take-up of billing codes for new primary care services complements with and substitutes for codes for other services. We use a panel regression and a matched county-level difference-in-differences design that compares high-intensity counties to low-intensity counties. We find evidence that Transitional Care substitutes for traditional post-discharge visits but complements with other forms of basic primary care as well as the provision of recommended care such as vaccinations and mammograms. We find less evidence that Chronic Care complements with other primary care services, and we find that Chronic Care is associated with a reduction in the provision of Imaging services.

Chapter 3 studies the Health Professional Shortage Area program, which increases the reimbursements paid by Medicare to physicians practicing in areas that are deemed to be experiencing a physician shortage. Using a matched difference-in-differences design, we find that the program has a positive effect on the stock of early-career physicians in designated counties. Furthermore, we find a response only for physicians who attended ranked medical schools. We discuss the policy implications of the fact that later-career physicians do not exhibit a response to the program despite receiving the bonus payments.