of care may harm patient outcomes, but existing studies of continuity disruption are limited by an inability to separate the association of continuity disruption from that of other physician-related factors.OBJECTIVES To examine changes in health care use and outcomes among patients whose primary care physician (PCP) exited the workforce and to directly measure the association of this primary care turnover with patients' health care use and outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used nationally representativeMedicare billing claims for a random sample of 359 470 Medicare fee-for-service beneficiaries with at least 1 PCP evaluation and management visit from January 1, 2008, to December 31, 2017. Primary care physicians who stopped practicing were identified and matched with PCPs who remained in practice. A difference-in-differences analysis compared health care use and clinical outcomes for patients who did lose PCPs with those who did not lose PCPs using subgroup analyses by practice size. Subgroup analyses were done on visits from January 1, 2008, to December 31, 2017. EXPOSURE Patients' loss of a PCP. MAIN OUTCOMES AND MEASURESPrimary care, specialty care, urgent care, emergency department, and inpatient visits, as well as overall spending for patients, were the primary outcomes. Receipt of appropriate preventive care and prescription fills were also examined. RESULTSDuring the study period, 9491 of 90 953 PCPs (10.4%) exited Medicare. We matched 169 870 beneficiaries whose PCP exited (37.2% women; mean [SD] age, 71.4 [6.1] years) with 189 600 beneficiaries whose PCP did not exit (36.9% women; mean [SD] age, 72.0 [5.0] years). The year after PCP exit, beneficiaries whose PCP exited had 18.4% (95% CI, −19.8% to −16.9%) fewer primary care visits and 6.2% (95% CI, 5.4%-7.0%) more specialty care visits compared with beneficiaries who did not lose a PCP. This outcome persisted 2 years after PCP exit. Beneficiaries whose PCP exited also had 17.8% (95% CI, 6.0%-29.7%) more urgent care visits, 3.1% (95% CI, 1.6%-4.6%) more emergency department visits, and greater spending

Background: Medical use of opioids has increased dramatically over the past 2 decades (1, 2), far exceeding increases in the prevalence of pain (3–5). This discrepancy may reflect efforts to address undertreatment of pain but has raised concerns about the appropriateness of physicians’ prescribing practices and whether patients’ medical indications justify opioid therapy. We therefore examined the indications associated with opioid prescriptions in ambulatory care between 2006 and 2015 to determine the proportion of prescriptions written for conditions causing pain. Objective: To determine the percentage of opioid prescriptions with a documented medical indication between 2006 and 2015, and to identify conditions commonly associated with opioid prescribing in ambulatory care. Methods and Findings: We used data from the National Ambulatory Medical Care Survey (NAMCS), an annual cross-sectional survey of visits to physician offices by insured and uninsured patients. For each visit, the NAMCS reports patient characteristics, prescribed medications, and up to 3 (between 2006 and 2013) or 5 (between 2014 and 2015) provider-assigned diagnoses denoting specific conditions discussed (recorded as International Classification of Diseases, Ninth Revision, codes).

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We study the welfare effects of offering choice over coverage levels—“vertical choice”—in regulated health insurance markets. We emphasize that heterogeneity in efficient coverage level is not sufficient to motivate choice. When premiums cannot reflect individuals’ costs, it may not be in consumers’ best interest to select their efficient coverage level. We show that vertical choice is efficient only if consumers with higher willingness to pay have a higher efficient level of coverage. We investigate this condition empirically and find that as long as a minimum coverage level can be enforced, the welfare gains from vertical choice are either zero or economically small. (JEL D82, G22, H75, I13, I21)

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