Doctoral Dissertation Research: The Impact of Managed Care on the Gender Gap Among Physicians

Harvard University, Cambridge MA

Investigators

Abstract

The advent and spread of managed care, beginning in the 1970s, has significantly increased product market competition in the health care industry. At the same time, the gains in relative earnings of female physicians over the last two decades have been remarkable. How might these two trends be related? Economic theory predicts that increased competition in the product market makes it more costly for consumers, colleagues, and employers to discriminate. Increased competition in the market for medical services, associated with the advent and spread of managed care, would be expected to lead to improvements in the relative earnings of discriminated groups such as women. This dissertation research examines this theory by comparing the change in earnings of women physicians to that of male physicians in states with high managed care growth to that in states with low managed care growth. Preliminary findings indicate that women physicians in states with high managed care growth narrowed the gender gap in hourly earnings by ten percentage points between 1986 and 1990 relative to women physicians in low managed care growth states. This nearly eliminates the gender gap in hourly earnings and reduces the gap in annual earnings by about a third. The preliminary findings yield only a snapshot of how changes in the market for medical services affect the gender gap among physicians. To sufficiently explore this topic in detail, this project utilizes data on a large sample: proprietary data collected by the American Medical Association on an annual basis since 1981. The AMA data allows one to track the supply and geographic distribution of the physician population, follow general trends that physicians face in the market for medical services, and note important changes in resource utilization and practice arrangements. In short, the AMA data will allow the principal investigator to build on the preliminary results already generated using less suitable sources of data.