Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health

TY - UNPB

T1 - Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health

AU - Simonsen, Marianne

AU - Skipper, Lars

AU - Skipper, Niels

AU - Thingholm, Peter Rønø

PY - 2019/6/24

Y1 - 2019/6/24

N2 - This paper investigates consequences of practice closures among primary care providers on subsequent patient health care utilization and health. Critically, the analysis relies on population-level administrative Danish data that facilitate a unique link between all Danes and their family doctor. We start by characterizing the nature of a practice closure, including the change in provider characteristics that occurs when patients change provider. Practice closure leads patients to choose a systematically younger and less experienced primary care provider. Using a difference-in-differences strategy that compares individuals who experience a practice closing with similar individuals enrolled in similar practices that do not close until later, we next investigate consequences for patient health care utilization and health outcomes. We find that a change in provider due to practice closure increases detection of chronic illness but does not lead to concurrent changes in primary care utilization. We do detect a considerable increase in the use of emergency care, however. A decomposition exercise shows that both physician practice style and the disruption itself plays a role for the total effects but that the direction of their relative influence varies across outcome domains. Importantly, disruption is not always negative from the perspective of the patient.

AB - This paper investigates consequences of practice closures among primary care providers on subsequent patient health care utilization and health. Critically, the analysis relies on population-level administrative Danish data that facilitate a unique link between all Danes and their family doctor. We start by characterizing the nature of a practice closure, including the change in provider characteristics that occurs when patients change provider. Practice closure leads patients to choose a systematically younger and less experienced primary care provider. Using a difference-in-differences strategy that compares individuals who experience a practice closing with similar individuals enrolled in similar practices that do not close until later, we next investigate consequences for patient health care utilization and health outcomes. We find that a change in provider due to practice closure increases detection of chronic illness but does not lead to concurrent changes in primary care utilization. We do detect a considerable increase in the use of emergency care, however. A decomposition exercise shows that both physician practice style and the disruption itself plays a role for the total effects but that the direction of their relative influence varies across outcome domains. Importantly, disruption is not always negative from the perspective of the patient.

KW - Physician practice closure, disruption, practice styles

M3 - Working paper

T3 - Economics Working Papers

BT - Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health

PB - Institut for Økonomi, Aarhus Universitet

CY - Aarhus

ER -