Discontinuity in Care: Clinic Closures among Primary Care Providers and Patient Health

This paper investigates consequences of clinic closures among primary care providers on subsequent patient health care utilization and health. As the population of physicians are growing increasingly older across the entire OECD, an increasingly number of patients eventually will experience that their primary care practice closes. As the primary care provider is central to the health management of the patients, it is critical to investigate the impact of disrupting the patient-provider relationship. Whereas prior research have found substantial negative impacts of such disruptions, our setting allows us to control for several channels previous work have not been able to include in their analysis. Pairing the high quality administrative Danish data with institutional features that assigns patients to new physicians, we are able to dissect to which extent the change in health care utilization is driven by changes in provider practice style or whether the disruption in itself plays a role.

Using a difference-in-differences strategy that compares individuals who experience a clinic closing with similar individuals enrolled in similar clinics that do not close until later, we formally investigate consequences for patient health care utilization and health outcomes. A change in provider due to clinic closure leads to increased detection of chronic illness (hypertension, hyperlipidemia, and diabetes) but does not lead to concurrent changes in primary care utilization or substitution into other types of health care (use of primary care physicians outside of normal office hours, use of specialists, or hospitalizations).

As it is the responsibility of local governments to make sure that each patient has access to care within a short distance, and because we see no effects on utilization, clinic size, and distance to clinic, we argue that our results stem from a combination of discontinuity of care and differences in practice style. We complete our empirical analysis with a decomposition of the overall effects into provider practice style and discontinuity of care. Results show that negative disruption effects in primary and secondary care utilization is off-set by increases in effects stemming from provider practice style. On the contrary, the (positive) disruption effect is the main contributor to the increases in diagnosis of chronic illness.