Discontinuity in Primary Care and its Effects on Healthcare Utilization – Evidence from Resigning German General Practitioners
A close and long-lasting relationship between general practitioners (GPs) and their patients is generally regarded as desirable and an essential factor in providing high-quality ambulatory care. The current demographic shift towards older populations in Western countries also affects the workforce in the healthcare sector. These older physicians will soon resign, challenging the continuity of care for patients. However, if the new GPs have superior knowledge and treatment styles compared to their predecessors, changing GPs can benefit the patients. Whether this is the case also depends on how quickly patients search for new doctors and how accessible primary care is in the healthcare system. We evaluate the effects of a disruption of the patient-provider relationship on healthcare utilization, changes in the practice styles between the old and new GP, and mortality using detailed administrative claims data from German statutory health insurance comprising almost 9 million insurees in an event-study setting. We contribute to a recent literature that uses event study methods to analyze the effect of physician exits on patients’ health care utilization and health outcomes. We analyze an interesting healthcare setting that may complement existing evidence namely the German social health insurance system. Notably, four of its features distinguish our setting from the literature. First, there is little restriction in the choice of physicians, which also means that patients do not receive any support in finding a new GP. Second, the insurance plans of the social health insurance do not exhibit any deductibles or copayments which can cause confounding effects as they censor healthcare utilization from below. Third, we study a general population that is almost unrestricted regarding age, employment, and socioeconomic characteristics. Finally, Germany has one of the highest physician densities, rendering the healthcare system highly accessible. Our findings suggest a significant and persistent reduction in the utilization of GP services, particularly driven by having regular contact with the GP. Hospital services, especially adverse emergency hospitalizations, seem to be an important substitute in the short run, but the persistence of preventable hospitalizations indicates decreased efficiency in healthcare provision. New GPs serve more patients. They also test less and prescribe more preventive drugs against cardiovascular diseases. Generally, practice style differences between old and new physicians cannot explain these effects, suggesting that new patients are treated differently than the new GP’s average patient. Although we do not find higher patient mortality rates, we find evidence that GP disruption reduces healthcare quality. After the old GPs exit, fewer chronic diseases are detected. Documenting these missed diagnoses is a novel finding in the literature.