title: The effect of the children's health insurance program on pediatricians' work hours.
abstract: OBJECTIVE
  Our study examines changes in physicians' work hours in response to a coverage expansion.
  
  
  METHODS
  We use as a natural experiment the Children's Health Insurance Program (CHIP), which was established in 1997 and significantly expanded children's eligibility for public health insurance coverage. The magnitude of the CHIP expansion varied across states and over time, allowing its effects to be identified using a state-year fixed effects model. We focus on pediatricians, and we measure their self-reported work hours using multiple waves (pre- and post-CHIP) of the physician survey component of the Community Tracking Study. To address endogeneity concerns, we instrument for CHIP enrollment using key program features (income eligibility cutoffs and waiting times).
  
  
  RESULTS
  We find a large negative relationship between the magnitude of a state's CHIP expansion and trends in pediatricians' work hours. This relationship could be due to key supply-side features of CHIP, including relatively low provider reimbursements and heavy use of managed care tools.
authors.affiliation: U.S. Government Accountability Office.
authors.forename: Fang
authors.initials: F
authors.lastname: He
authors.affiliation: Center for Studying Health System Change.
authors.forename: Chapin
authors.initials: C
authors.lastname: White
mesh_terms: D002648:Child; D002662:Child Health Services; D002669:Child Welfare; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000706:statistics & numerical data*; D013221:State Health Plans / Q000706:statistics & numerical data; D014481:United States; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*
keywords: Children's Health Insurance Program; Community Tracking Study; health insurance; labor supply; pediatrician
references.citation: Health Serv Res. 2007 Aug;42(4):1544-63
references.pmid: 17610437
references.citation: J Health Econ. 2007 Dec 1;26(6):1151-69
references.pmid: 17920714
references.citation: Ann Intern Med. 2004 Nov 2;141(9):705-14
references.pmid: 15520427
references.citation: N Engl J Med. 1961 Dec 14;265:1187-94
references.pmid: 13917165
references.citation: N Engl J Med. 1973 Nov 29;289(22):1174-8
references.pmid: 4754965
references.citation: Health Serv Res. 2007 Aug;42(4):1520-43
references.pmid: 17610436
references.citation: Health Serv Res. 1997 Aug;32(3):283-98
references.pmid: 9240281
references.citation: Pediatrics. 1987 Sep;80(3):344-50
references.pmid: 3627885
references.citation: JAMA. 2010 Feb 24;303(8):747-53
references.pmid: 20179284
references.citation: Pediatrics. 2002 Jun;109(6):1015-20
references.pmid: 12042537
references.citation: J Health Econ. 2008 Mar;27(2):201-17
references.pmid: 18206255
references.citation: Health Aff (Millwood). 2009 May-Jun;28(3):w510-9
references.pmid: 19401290
references.citation: J Health Econ. 2008 Dec;27(6):1567-81
references.pmid: 18707781
references.citation: Inquiry. 2009-2010 Winter;46(4):372-90
references.pmid: 20184165
references.citation: J Policy Anal Manage. 2007 Winter;26(1):149-75
references.pmid: 17312602
references.citation: Health Care Financ Rev. 1995 Fall;17(1):167-81
references.pmid: 10153470
references.citation: Health Aff (Millwood). 2004 Jan-Jun;Suppl Web Exclusives:W4-374-84
references.pmid: 15451955
references.citation: Pediatrics. 2005 Jul;116(1):e34-42
references.pmid: 15958662
references.citation: J Health Econ. 2002 Mar;21(2):337-53
references.pmid: 11939245
references.citation: N Engl J Med. 1973 May 31;288(22):1152-5
references.pmid: 4699745