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Primary Care Physician Practice Styles and Patient Care: Evidence from Physician Exits in Medicare

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  • Itzik Fadlon
  • Jessica N. Van Parys

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

  • Itzik Fadlon & Jessica N. Van Parys, 2019. "Primary Care Physician Practice Styles and Patient Care: Evidence from Physician Exits in Medicare," NBER Working Papers 26269, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:26269
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    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, Oxford University Press, vol. 131(4), pages 1681-1726.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
    15. 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.
    16. Alkalay, Adi & Eizenberg, Alon & Lahad, Amnon & Shurtz, Ity, 2018. "Physician workload and treatment choice: the case of primary care," CEPR Discussion Papers 13157, C.E.P.R. Discussion Papers.
    17. 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.
    18. 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.
    19. 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.
    20. Grytten, Jostein & Sorensen, Rune, 2003. "Practice variation and physician-specific effects," Journal of Health Economics, Elsevier, vol. 22(3), pages 403-418, May.
    21. 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.
    22. 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.
    23. 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.
    24. 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.
    25. Alan M. Garber & Jonathan Skinner, 2008. "Is American Health Care Uniquely Inefficient?," NBER Working Papers 14257, National Bureau of Economic Research, Inc.
    26. 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.
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    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. 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.
    3. 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.

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    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

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