IDEAS home Printed from https://ideas.repec.org/a/eee/jhecon/v71y2020ics0167629619308367.html
   My bibliography  Save this article

Primary care physician practice styles and patient care: Evidence from physician exits in Medicare

Author

Listed:
  • Fadlon, Itzik
  • Van Parys, Jessica

Abstract

Primary care physicians (PCPs) provide frontline health care to patients in the U.S.; however, it is unclear how their practice styles affect patient care. In this paper, we estimate the long-lasting effects of PCP practice styles on patient health care utilization by focusing on Medicare patients affected by PCP relocations or retirements, which we refer to as “exits.” Observing where patients receive care after these exits, we estimate event studies to compare patients who switch to PCPs with different practice style intensities. We find that PCPs have large effects on a range of aggregate utilization measures, including physician and outpatient spending and the number of diagnosed conditions. Moreover, we find that PCPs have large effects on the quality of care that patients receive, and that all of these effects persist for several years. Our results suggest that switching to higher-quality PCPs could significantly affect patients’ longer-run health outcomes.

Suggested Citation

  • Fadlon, Itzik & Van Parys, Jessica, 2020. "Primary care physician practice styles and patient care: Evidence from physician exits in Medicare," Journal of Health Economics, Elsevier, vol. 71(C).
  • Handle: RePEc:eee:jhecon:v:71:y:2020:i:c:s0167629619308367
    DOI: 10.1016/j.jhealeco.2020.102304
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0167629619308367
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.jhealeco.2020.102304?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Leila Agha & Keith Marzilli Ericson & Kimberley H. Geissler & James B. Rebitzer, 2018. "Team Formation and Performance: Evidence from Healthcare Referral Networks," NBER Working Papers 24338, National Bureau of Economic Research, Inc.
    2. Martha J. Bailey & Andrew Goodman-Bacon, 2015. "The War on Poverty's Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans," American Economic Review, American Economic Association, vol. 105(3), pages 1067-1104, March.
    3. David M. Cutler & Dan P. Ly, 2011. "The (Paper)Work of Medicine: Understanding International Medical Costs," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 3-25, Spring.
    4. Joseph J. Doyle Jr. & John A. Graves & Jonathan Gruber & Samuel A. Kleiner, 2015. "Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns," Journal of Political Economy, University of Chicago Press, vol. 123(1), pages 170-214.
    5. Ity Shurtz & Alon Eizenberg & Adi Alkalay & Amnon Lahad, 2022. "Physician workload and treatment choice: the case of primary care," RAND Journal of Economics, RAND Corporation, vol. 53(4), pages 763-791, December.
    6. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    7. Andrew J. Epstein & Sean Nicholson & David A. Asch, 2016. "The Production of and Market for New Physicians’ Skill," American Journal of Health Economics, MIT Press, vol. 2(1), pages 41-65, Winter.
    8. David Molitor, 2018. "The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 326-356, February.
    9. Papanicolas, Irene & Woskie, Liana R. & Jha, Ashish K., 2018. "Health care spending in the United States and other high-income countries," LSE Research Online Documents on Economics 87362, London School of Economics and Political Science, LSE Library.
    10. Sergei Koulayev & Emilia Simeonova & Niels Skipper, 2017. "Can Physicians Affect Patient Adherence With Medication?," Health Economics, John Wiley & Sons, Ltd., vol. 26(6), pages 779-794, June.
    11. Currie, Janet & MacLeod, W. Bentley & Van Parys, Jessica, 2016. "Provider practice style and patient health outcomes: The case of heart attacks," Journal of Health Economics, Elsevier, vol. 47(C), pages 64-80.
    12. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    13. Alan M. Garber & Jonathan Skinner, 2008. "Is American Health Care Uniquely Inefficient?," NBER Working Papers 14257, National Bureau of Economic Research, Inc.
    14. Marika Cabral & Mark R. Cullen, 2017. "The Effect Of Insurance Coverage On Preventive Care," Economic Inquiry, Western Economic Association International, vol. 55(3), pages 1452-1467, July.
    15. David C. Chan, 2016. "Teamwork and Moral Hazard: Evidence from the Emergency Department," Journal of Political Economy, University of Chicago Press, vol. 124(3), pages 734-770.
    16. Alan M. Garber & Jonathan Skinner, 2008. "Is American Health Care Uniquely Inefficient?," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 27-50, Fall.
    17. Jessica Van Parys, 2016. "Variation in Physician Practice Styles within and across Emergency Departments," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-19, August.
    18. Andrew J. Epstein & Sean Nicholson & David A. Asch, 2016. "The Production of and Market for New Physicians’ Skill," American Journal of Health Economics, University of Chicago Press, vol. 2(1), pages 41-65, Winter.
    19. Joseph J. Doyle, 2011. "Returns to Local-Area Health Care Spending: Evidence from Health Shocks to Patients Far from Home," American Economic Journal: Applied Economics, American Economic Association, vol. 3(3), pages 221-243, July.
    20. Nicky J. Welton & Howard H. Z. Thom, 2015. "Value of Information," Medical Decision Making, , vol. 35(5), pages 564-566, July.
    21. Gautam Gowrisankaran & Keith A. Joiner & Pierre-Thomas Léger, 2017. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," NBER Working Papers 24155, National Bureau of Economic Research, Inc.
    22. David Cutler & Jonathan S. Skinner & Ariel Dora Stern & David Wennberg, 2019. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 192-221, February.
    23. Grytten, Jostein & Sorensen, Rune, 2003. "Practice variation and physician-specific effects," Journal of Health Economics, Elsevier, vol. 22(3), pages 403-418, May.
    24. Marianne Simonsen & Lars Skipper & Niels Skipper & Peter Rønø Thingholm, 2019. "Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health," Economics Working Papers 2019-08, Department of Economics and Business Economics, Aarhus University.
    25. Jonathan Gruber & Thomas P. Hoe & George Stoye, 2018. "Saving Lives by Tying Hands: The Unexpected Effects of Constraining Health Care Providers," NBER Working Papers 24445, National Bureau of Economic Research, Inc.
    26. Andrew J. Epstein & Sean Nicholson & David A. Asch, 2016. "The Production of and Market for New Physicians’ Skill," American Journal of Health Economics, MIT Press, vol. 2(1), pages 41-65, January.
    27. Jason M. Fletcher & Leora I. Horwitz & Elizabeth Bradley, 2014. "Estimating the Value Added of Attending Physicians on Patient Outcomes," NBER Working Papers 20534, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Leila Agha & Keith Marzilli Ericson & Xiaoxi Zhao, 2020. "The Impact of Organizational Boundaries on Healthcare Coordination and Utilization," NBER Working Papers 28179, National Bureau of Economic Research, Inc.
    2. Simonsen, Marianne & Skipper, Lars & Skipper, Niels & Thingholm, Peter Rønø, 2021. "Discontinuity in care: Practice closures among primary care providers and patient health care utilization," Journal of Health Economics, Elsevier, vol. 80(C).
    3. 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).
    4. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    5. Shan Huang & Hannes Ullrich, 2021. "Physician Effects in Antibiotic Prescribing: Evidence from Physician Exits," Discussion Papers of DIW Berlin 1958, DIW Berlin, German Institute for Economic Research.
    6. Ivan Badinski & Amy Finkelstein & Matthew Gentzkow & Peter Hull, 2023. "Geographic Variation in Healthcare Utilization: The Role of Physicians," NBER Working Papers 31749, National Bureau of Economic Research, Inc.
    7. Michael L. Barnett & Andrew Olenski & Adam Sacarny, 2023. "Common Practice: Spillovers from Medicare on Private Health Care," American Economic Journal: Economic Policy, American Economic Association, vol. 15(3), pages 65-88, August.
    8. Amy Finkelstein & Matthew Gentzkow & Dean Li & Heidi L. Williams, 2022. "What Drives Risky Prescription Opioid Use? Evidence from Migration," NBER Working Papers 30471, National Bureau of Economic Research, Inc.
    9. Staiger, Becky, 2022. "Disruptions to the patient-provider relationship and patient utilization and outcomes: Evidence from medicaid managed care," Journal of Health Economics, Elsevier, vol. 81(C).
    10. Zhang, Xuan, 2022. "The effects of physician retirement on patient outcomes: Anticipation and disruption," Journal of Public Economics, Elsevier, vol. 207(C).
    11. Dahlstrand Rudin, Amanda, 2022. "Defying distance? The provision of services in the digital age," LSE Research Online Documents on Economics 118042, London School of Economics and Political Science, LSE Library.
    12. Dahl, Gordon B. & Forbes, Silke J., 2023. "Doctor switching costs," Journal of Public Economics, Elsevier, vol. 221(C).
    13. Peter Rønø Thingholm, 2023. "Provider Spill-Overs in Opioid Prescription Leniency and Patient – Labor Market Outcomes," Economics Working Papers 2023-05, Department of Economics and Business Economics, Aarhus University.
    14. 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.
    15. Zocher, Katrin, 2022. "Exiting primary care providers," EconStor Preprints 249041, ZBW - Leibniz Information Centre for Economics, revised 2022.
    16. Eichmeyer, Sarah & Zhang, Jonathan, 2023. "Primary care providers’ influence on opioid use and its adverse consequences," Journal of Public Economics, Elsevier, vol. 217(C).
    17. Ida Lykke Kristiansen & Sophie Yanying Sheng, 2022. "Doctor Who? The Effect of Physician-Patient Match on The SES-Health Gradient," CEBI working paper series 22-05, University of Copenhagen. Department of Economics. The Center for Economic Behavior and Inequality (CEBI).
    18. Sabety, Adrienne, 2023. "The value of relationships in healthcare," Journal of Public Economics, Elsevier, vol. 225(C).
    19. Amanda Dahlstrand, 2022. "Defying distance? The provision of services in the digital age," CEP Discussion Papers dp1889, Centre for Economic Performance, LSE.
    20. Stefan Sliwa Ruiz & Malte Becker & Thomas Hone & Rudi Rocha, 2023. "Doctor Turnover and Health Outcomes: Evidence from the Exit of Cuban Doctors in Brazil," Working Papers 18, Instituto de Estudos para Políticas de Saúde.
    21. Shan Huang & Hannes Ullrich, 2023. "Provider effects in antibiotic prescribing: Evidence from physician exits," Berlin School of Economics Discussion Papers 0018, Berlin School of Economics.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    2. Ivan Badinski & Amy Finkelstein & Matthew Gentzkow & Peter Hull, 2023. "Geographic Variation in Healthcare Utilization: The Role of Physicians," NBER Working Papers 31749, National Bureau of Economic Research, Inc.
    3. Peter Rønø Thingholm, 2023. "Provider Spill-Overs in Opioid Prescription Leniency and Patient – Labor Market Outcomes," Economics Working Papers 2023-05, Department of Economics and Business Economics, Aarhus University.
    4. Leila Agha & Keith Marzilli Ericson & Xiaoxi Zhao, 2020. "The Impact of Organizational Boundaries on Healthcare Coordination and Utilization," NBER Working Papers 28179, National Bureau of Economic Research, Inc.
    5. Böckerman, Petri & Laine, Liisa T. & Nurminen, Mikko & Saxell, Tanja, 2020. "Information Integration, Coordination Failures, and Quality of Prescribing," IZA Discussion Papers 13926, Institute of Labor Economics (IZA).
    6. Avdic, Daniel & Blankart, Katharina, 2021. "A Hard Look at “Soft” Cost‐control Measures in Healthcare Organizations: Evidence from Preferred Drug Policies in Germany," CINCH Working Paper Series (since 2020) 74978, Duisburg-Essen University Library, DuEPublico.
    7. Shan Huang & Hannes Ullrich, 2021. "Physician Effects in Antibiotic Prescribing: Evidence from Physician Exits," Discussion Papers of DIW Berlin 1958, DIW Berlin, German Institute for Economic Research.
    8. Barrenho, Eliana & Miraldo, Marisa & Propper, Carol & Walsh, Brendan, 2021. "The importance of surgeons and their peers in adoption and diffusion of innovation: An observational study of laparoscopic colectomy adoption and diffusion in England," Social Science & Medicine, Elsevier, vol. 272(C).
    9. Simon Bensnes, 2021. "Time to spare and too much care. Congestion and overtreatment at the maternity ward," Discussion Papers 963, Statistics Norway, Research Department.
    10. Gautam Gowrisankaran & Keith Joiner & Pierre Thomas Léger, 2023. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," Management Science, INFORMS, vol. 69(6), pages 3202-3219, June.
    11. Gautam Gowrisankaran & Keith A. Joiner & Pierre-Thomas Léger, 2017. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," NBER Working Papers 24155, National Bureau of Economic Research, Inc.
    12. Simonsen, Marianne & Skipper, Lars & Skipper, Niels & Thingholm, Peter Rønø, 2021. "Discontinuity in care: Practice closures among primary care providers and patient health care utilization," Journal of Health Economics, Elsevier, vol. 80(C).
    13. Shan Huang & Hannes Ullrich, 2023. "Provider effects in antibiotic prescribing: Evidence from physician exits," Berlin School of Economics Discussion Papers 0018, Berlin School of Economics.
    14. Lundborg, Petter & James, Stefan & Lagerqvist, Bo & Vikström, Johan, 2021. "Learning-by-Doing and Productivity Growth among High-Skilled Workers: Evidence from the Treatment of Heart Attacks," IZA Discussion Papers 14744, Institute of Labor Economics (IZA).
    15. Geruso, Michael & Richards, Michael R., 2022. "Trading spaces: Medicare's regulatory spillovers on treatment setting for non-Medicare patients," Journal of Health Economics, Elsevier, vol. 84(C).
    16. Emilia Simeonova & Niels Skipper & Peter R. Thingholm, 2020. "Physician Health Management Skills and Patient Outcomes," NBER Working Papers 26735, National Bureau of Economic Research, Inc.
    17. Amitabh Chandra & Carrie H. Colla & Jonathan S. Skinner, 2023. "Productivity Variation and Input Misallocation: Evidence from Hospitals," NBER Working Papers 31569, National Bureau of Economic Research, Inc.
    18. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Neighborhoods, networks, and delivery methods," Journal of Health Economics, Elsevier, vol. 80(C).
    19. Alexander Ahammer & Thomas Schober, 2020. "Exploring variations in health‐care expenditures—What is the role of practice styles?," Health Economics, John Wiley & Sons, Ltd., vol. 29(6), pages 683-699, June.
    20. Bensnes, Simon & Huitfeldt, Ingrid, 2021. "Rumor has it: How do patients respond to patient-generated physician ratings?," Journal of Health Economics, Elsevier, vol. 76(C).

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:jhecon:v:71:y:2020:i:c:s0167629619308367. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505560 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.