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Title page
Contents
Abstract 3
1. Introduction 4
2. Background 8
2.1. Federal funding for graduate medical education 8
2.2. Section 5503 resident cap redistribution 9
2.3. The Match 14
3. Data 15
3.1. Hospital cost reports 15
3.2. Area Health Resource File 18
3.3. National Residency Matching Program reports 18
4. Estimation and identification 21
5. Results 25
5.1. Resident utilization 25
5.2. Residency program size 27
5.3. Primary care physician supply 28
6. Perfect conversion counterfactual 30
7. Conclusion 32
References 34
Appendix A. Figures 39
Appendix B. Tables 45
Table 1. Summary statistics and exogeneity of instrument for hospital analysis data 17
Table 2. Summary statistics and exogeneity of instrument for county analysis data 19
Table 3. Summary statistics for program analysis data 20
Table 4. Computation of cumulative effect of Section 5503 on PCP supply per 100 beds under perfect conversion using estimates from Figure 7 31
Figure 1. Trend in average physician supply in rural and urban counties 4
Figure 2. Divergence between resident counts and caps 9
Figure 3. Illustration of Section 5503 eligibility and allocation criteria 11
Figure 4. Trend in resident caps for hospitals by treatment status 13
Figure 5. Match rates across specialties 14
Figure 6. Mean quota and number matched for programs stratified by eligibility for a cap increase under Section 5503 21
Figure 7. Estimation results for the effect of Section 5503 on teaching hospital residents per 100 beds 26
Figure 8. Estimation results for the effect of Section 5503 on program Match outcomes 28
Figure 9. Estimation results for the percent effect of Section 5503 on county primary care physician counts 29
Table B1. Summary of first stage estimates 46
Figure A1. Trend in resident hourly real wage for hospitals that received cap increases and control hospitals 39
Figure A2. Trend in distribution of hourly real wages 40
Figure A3. Estimation results for the effect of a one slot increase in resident cap from Section 5503 on hospital residents per 100 beds 41
Figure A4. Estimation results for the effect of a one percent increase in residency subsidies from Section 5503 on hospital residents per 100 beds 42
Figure A5. Estimation results for the effect of Section 5503 on other hospital employment per 100 beds 43
Figure A6. Estimation results for the percent effect of a one slot increase in the cumulative resident cap on county primary care physician counts 44
Figure A7. Estimation results for the percent effect of a one percent increase in residency subsidies from Section 5503 on county primary care physician counts 45
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