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Impact of early primary care follow-up after discharge on hospital readmissions


  • Damien Bricard

    (Institut de Recherche et de Documentation en Economie de la Santé (IRDES))

  • Zeynep Or

    (Institut de Recherche et de Documentation en Economie de la Santé (IRDES))


Reducing repeated hospitalizations of patients with chronic conditions is a policy objective for improving system efficiency. We test the hypothesis that the risk of readmission is associated with the timing and intensity of primary care follow-up after discharge, focusing on patients hospitalized for heart failure in France. We propose a discrete-time model which takes into account that primary care treatments have a lagged and cumulative effect on readmission risk, and an instrumental variable approach, exploiting geographical differences in availability of generalists. We show that the early consultations with a GP after discharge can reduce the 28-day readmission risk by almost 50%, and that patients with higher ambulatory care utilization have smaller odds of readmission. Furthermore, geographical disparities in primary care affect indirectly the readmission risk. These results suggest that interventions which strengthen communication between hospitals and generalists are elemental for reducing readmissions and for developing effective strategies at the hospital level, it is also necessary to consider primary care resources that are available to patients.

Suggested Citation

  • Damien Bricard & Zeynep Or, 2019. "Impact of early primary care follow-up after discharge on hospital readmissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 611-623, June.
  • Handle: RePEc:spr:eujhec:v:20:y:2019:i:4:d:10.1007_s10198-018-1022-y
    DOI: 10.1007/s10198-018-1022-y

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    References listed on IDEAS

    1. Amitabh Chandra & Douglas O. Staiger, 2007. "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks," Journal of Political Economy, University of Chicago Press, vol. 115(1), pages 103-140.
    2. Dourgnon, Paul & Naiditch, Michel, 2010. "The preferred doctor scheme: A political reading of a French experiment of Gate-keeping," Health Policy, Elsevier, vol. 94(2), pages 129-134, February.
    3. Deborah Peikes & Arnold Chen & Jennifer Schore & Randall Brown, 2009. "Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials," Mathematica Policy Research Reports ce70f11be1b44e2c8590b9cf5, Mathematica Policy Research.
    4. Cutler, David M., 2007. "The lifetime costs and benefits of medical technology," Journal of Health Economics, Elsevier, vol. 26(6), pages 1081-1100, December.
    5. Laudicella, Mauro & Li Donni, Paolo & Smith, Peter C., 2013. "Hospital readmission rates: Signal of failure or success?," Journal of Health Economics, Elsevier, vol. 32(5), pages 909-921.
    6. Jenkins, Stephen P, 1995. "Easy Estimation Methods for Discrete-Time Duration Models," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 57(1), pages 129-138, February.
    7. Ho, Vivian & Hamilton, Barton H., 2000. "Hospital mergers and acquisitions: does market consolidation harm patients?," Journal of Health Economics, Elsevier, vol. 19(5), pages 767-791, September.
    8. repec:mpr:mprres:6184 is not listed on IDEAS
    9. Laura Vallejo-Torres & Stephen Morris, 2018. "Primary care supply and quality of care in England," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(4), pages 499-519, May.
    10. Deborah Peikes & Arnold Chen & Jennifer Schore & Randall Brown, "undated". "Paper of the Year: Effects of Care Coordination on Hospitalization Quality of Care and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials (JAMA 2009)," Mathematica Policy Research Reports 05bbbc49ae314e1494a855ccb, Mathematica Policy Research.
    11. Cawley, John & Markowitz, Sara & Tauras, John, 2004. "Lighting up and slimming down: the effects of body weight and cigarette prices on adolescent smoking initiation," Journal of Health Economics, Elsevier, vol. 23(2), pages 293-311, March.
    12. Terza, Joseph V. & Basu, Anirban & Rathouz, Paul J., 2008. "Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling," Journal of Health Economics, Elsevier, vol. 27(3), pages 531-543, May.
    13. Zeynep Or & Anne Penneau, 2017. "Analyse des déterminants territoriaux du recours aux urgences non suivi d’une hospitalisation," Working Papers DT72, IRDES institut for research and information in health economics, revised Sep 2017.
    14. Cutler, David, 2007. "The Lifetime Costs and Benefits of Medical Technology," Scholarly Articles 2643640, Harvard University Department of Economics.
    15. Jones, Andrew M. & Rice, Nigel & Roberts, Jennifer, 2010. "Sick of work or too sick to work? Evidence on self-reported health shocks and early retirement from the BHPS," Economic Modelling, Elsevier, vol. 27(4), pages 866-880, July.
    16. Kristensen, Søren Rud & Bech, Mickael & Quentin, Wilm, 2015. "A roadmap for comparing readmission policies with application to Denmark, England, Germany and the United States," Health Policy, Elsevier, vol. 119(3), pages 264-273.
    17. repec:imp:wpaper:9224 is not listed on IDEAS
    18. Coyte, Peter C. & Young, Wendy & Croxford, Ruth, 2000. "Costs and outcomes associated with alternative discharge strategies following joint replacement surgery: analysis of an observational study using a propensity score," Journal of Health Economics, Elsevier, vol. 19(6), pages 907-929, November.
    19. repec:dau:papers:123456789/12227 is not listed on IDEAS
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    Cited by:

    1. Zocher, Katrin, 2022. "Exiting primary care providers," EconStor Preprints 249041, ZBW - Leibniz Information Centre for Economics, revised 2022.

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    More about this item


    Readmissions; Primary care; Hospital; Instrumental variable; Discrete-time model;
    All these keywords.

    JEL classification:

    • C22 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Time-Series Models; Dynamic Quantile Regressions; Dynamic Treatment Effect Models; Diffusion Processes
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • L24 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Contracting Out; Joint Ventures


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