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

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  • Tamara Bischof
  • Boris Kaiser
Abstract
This paper investigates the consequences that patients face when their regular general practitioner (GP) closes down her practice, typically due to retirement. We estimate the causal impact of closures on patients' utilization patterns, healthcare expenditures, hospitalizations, mortality, and health plan choices. Employing a difference‐in‐difference framework, we find that patients who experience a discontinuity of care persistently adjust their ambulatory utilization pattern by shifting visits away from GPs (−12%) toward specialists (+11%) and hospital outpatient facilities (+6%). In contrast, we find no evidence on adverse health effects as measured by hospitalizations and mortality. The impact on utilization is heterogeneous along several dimensions. In particular, we find geographic disparities between regions with high and low availability of primary care. We also observe that patients with chronic conditions substitute more strongly toward other providers. Our results have potential implications for health policy in at least two dimensions: first, practice closures lead to more fragmented care which may entail inefficiencies, and second, closures deteriorate access to primary care in regions with low physician density.

Suggested Citation

  • Tamara Bischof & Boris Kaiser, 2021. "Who cares when you close down? The effects of primary care practice closures on patients," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2004-2025, September.
    • Handle: RePEc:wly:hlthec:v:30:y:2021:i:9:p:2004-2025
    DOI: 10.1002/hec.4287
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    Cited by:

    1. Hjalmarsson, Linn & Kaiser, Boris & Bischof, Tamara, 2023. "The impact of physician exits in primary care: A study of practice handovers," Health Policy, Elsevier, vol. 135(C).
    2. Anikó Bíró & Blanka Imre, 2022. "Financial subsidies and the shortage of primary care physicians," CERS-IE WORKING PAPERS 2210, Institute of Economics, Centre for Economic and Regional Studies.
    3. Monsees, Daniel & Westphal, Matthias, 2024. "Disruptions in primary care: Can resigning GPs cause persistently negative health effects?," Ruhr Economic Papers 1082, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    4. Zhang, Xuan, 2022. "The effects of physician retirement on patient outcomes: Anticipation and disruption," Journal of Public Economics, Elsevier, vol. 207(C).
    5. Katrin Zocher, 2024. "Exiting primary care providers," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 1033-1054, May.
    6. Zocher, Katrin, 2022. "Exiting primary care providers," EconStor Preprints 249041, ZBW - Leibniz Information Centre for Economics, revised 2022.
    7. Sabety, Adrienne, 2023. "The value of relationships in healthcare," Journal of Public Economics, Elsevier, vol. 225(C).

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    More about this item

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I31 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - General Welfare, Well-Being

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