Medicare is a roughly $700 billion public program, with physician payments representing one of its largest expenditures. Medicare's prices are also administratively set, which leaves the structure of payment changes subject to a political process that may introduce idiosyncratic features and even perverse incentives. At the same time, physician responses to changes in Medicare reimbursements are likely to vary according to the policy's duration, scope, and size. We study a setting where broad federal laws contained specific provisions that financially benefit a narrow group: Alaskan physicians. The geographically targeted payment reforms were also unique along key dimensions. Using difference-in-differences strategies, we find that large, temporary price changes increase spending but elicit no detectable supply response. Conversely, generous and permanent price shocks induce greater service flows but not uniformly across specialties. Our findings suggest that Congress may engage in fiscally inefficient Medicare spending to accomplish other legislative objectives.

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医生会接受更高的医疗保险价格吗？来自阿拉斯加的证据

医疗保险是一项大约 7000 亿美元的公共计划，其中医生支付是其最大的支出之一。医疗保险的价格也是由行政决定的，这使得支付结构的变化受制于可能引入特殊特征甚至不正当激励措施的政治过程。同时，医生对医疗保险报销变化的反应可能会根据政策的持续时间、范围和规模而有所不同。我们研究了一个广泛的联邦法律包含特定条款的环境，这些条款在经济上使一小群人受益：阿拉斯加医生。以地域为目标的支付改革在关键方面也是独一无二的。使用差异中的差异策略，我们发现大的、临时的价格变化会增加支出，但不会引起可察觉的供应反应。反过来，慷慨而持久的价格冲击会导致更大的服务流动，但在各专业之间并不统一。我们的研究结果表明，国会可能会通过财政效率低下的医疗保险支出来实现其他立法目标。