Public health insurance expansions and non‐physician providers: Evidence from Certified Nurse Midwives
研究《平价医疗法案》的医疗补助扩展是否改变了产科护理中医生与认证助产士的使用比例，发现扩展增加了助产士的使用，尤其在报销平等的州。
Abstract This study considers whether the Affordable Care Act (ACA) Medicaid expansions resulted in changes in the use of non‐physician providers. Medicaid expansions may have impacted both payments to providers as well as insurance availability for patients. Using U.S. birth certificate records, we analyze whether the ACA Medicaid expansions influenced the trade‐off between physicians and certified nurse‐midwives (CNMs/CMs) for obstetric care. Our findings indicate that the ACA Medicaid expansions led to an increase in the utilization of CNMs/CMs and a decrease in physician‐reported deliveries. This shift from physicians to CNMs/CMs is particularly noticeable in states with Medicaid reimbursement parity for CNMs/CMs. These results suggest that health insurance expansions may increase the use of non‐physician providers, but only in cases where non‐physician providers are reimbursed similarly to physicians.