ABSTRACT

This paper exploits practice closures to estimate the causal impacts of primary care practice closures on patients’ utilization patterns, medical expenditures and health- related outcomes. Employing a difference-in-difference framework, we identify causal effects by comparing changes in outcomes between an affected group of patients (‘treatment group’) and an unaffected group that does not experience changes in primary care provision (‘control group’). We use a large patient-provider panel dataset based on insurance claims from a major Swiss health insurer. Our main findings suggest that patients adjust their utilization patterns significantly when their main source of primary care closes: their overall GP visits fall sharply, while visits to specialists and outpatient departments of hospitals increase. In addition, practice closures alter insurance plan choices. The evidence suggests that practice closures have economically relevant and persistent effects on health care utilization. The findings have implications for health care policy regarding the provision of continuous primary care and the planning of the health care workforce.