Discontinuity in care: Practice closures among primary care providers and patient health care utilization

Who cares when you close down? The effects of primary care practice closures on patients

“…Interestingly, Simonsen et al. (2019) report increased detection rates of chronic conditions, which indicates that a discontinuity in primary care may also have positive effects. Our setting differs somewhat from the papers mentioned above.…”

“…We contribute to a small contemporary literature that studies how physician moves or exits affect patients' utilization and outcomes (Fadlon & Van Parys, 2019; Kwok, 2019; Piwnica‐Worms et al., 2021; Schwab, 2018; Simonsen et al., 2019). For example, Fadlon and Van Parys (2019) find that switching to a provider with a more intensive practice style considerably increases utilization and expenditures, especially for outcomes directly related to primary care such as the number of primary care visits.…”

“…Third, in Switzerland, patients face search costs when their regular primary care practice closes down because they have to actively enroll with a new GP. In contrast, in the concurrent studies, health authorities assist patients with transferring to a new provider (Schwab, 2018; Simonsen et al., 2019) or (some) patients may transition to a different doctor within the same practice (Fadlon & Van Parys, 2019; Kwok, 2019). Finally, our paper is the first to analyze the effect heterogeneity across regions that differ in their availability of primary care, and to explore effects on insurance choice.…”

“…The distinction is relevant because a practice closure both disrupts the patient-provider relationship and changes the availability of primary care. Second, the papers on the United States study the impact on the elderly population enrolled in the US Medicare system (Fadlon & Van Parys, 2019;Kwok, 2019) or military personnel (Schwab, 2018), while our data includes all adult age groups, similar to Simonsen et al (2019) who use Danish data. Third, in Switzerland, patients face search costs when their regular primary care practice closes down because they have to actively enroll with a new GP.…”

Does Your Doctor Matter? Doctor Quality and Patient Outcomes

“…In our sample, each previous GP transfers patients to on average 7 new GPs (SD 10.8); in each of these transfers, an average of 11.5 patients are moved from a previous to a new GP (Appendix Table A.1). An added benefit with focusing on GP reassignments is that when patients match to new physicians, there is a consequential reassessment of patients' medical needs (Simonsen et al 2021). This is ideal for the purpose of our exercise, as it improves our ability to identify quality effects.…”