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

This paper investigates consequences of practice closures among primary care providers on subsequent patient health care utilization and health. Critically, the analysis relies on population-level administrative Danish data that facilitate a unique link between all Danes and their family doctor. We start by characterizing the nature of a practice closure, including the change in provider characteristics that occurs when patients change provider. Practice closure leads patients to choose a systematically younger and less experienced primary care provider. Using a difference-in-differences strategy that compares individuals who experience a practice closing with similar individuals enrolled in similar practices that do not close until later, we next investigate consequences for patient health care utilization and health outcomes. We find that a change in provider due to practice closure increases detection of chronic illness but does not lead to concurrent changes in primary care utilization. We do detect a considerable increase in the use of emergency care, however. A decomposition exercise shows that both physician practice style and the disruption itself plays a role for the total effects but that the direction of their relative influence varies across outcome domains. Importantly, disruption is not always negative from the perspective of the patient.