IDEAS home Printed from https://ideas.repec.org/p/zbw/rwirep/298849.html

Disruptions in primary care: Can resigning GPs cause persistently negative health effects?

Author

Listed:
  • Monsees, Daniel
  • Westphal, Matthias

Abstract

We study the effects of general practitioners' (GPs') resignations on their patients' healthcare utilization, diagnoses, and mortality in an event-study setting. Using claims data from a large German statutory health insurance, we find that after physicians leave, their former patients persistently reduce their primary care utilization, only partially substituting it with specialist visits and hospital care. Because patients find a new GP already 1.1 quarters after the old resigns, on average, the persistent effects must be explained through the new GP. Indeed, we find that the new GP serves more patients but performs less diagnostic testing. While we do not find evidence for mortality, our results reveal a substantial decrease in diagnoses of chronic conditions (such as congestive heart failure and diabetes), suggesting that disruptions may have adverse consequences for the efficiency of the healthcare system. This indicates that continuity in primary care is pivotal and shows that the GP has an important role in healthcare delivery.

Suggested Citation

  • Monsees, Daniel & Westphal, Matthias, 2024. "Disruptions in primary care: Can resigning GPs cause persistently negative health effects?," Ruhr Economic Papers 1082, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    • Handle: RePEc:zbw:rwirep:298849
    DOI: 10.4419/96973257
    as

    Download full text from publisher

    File URL: https://www.econstor.eu/bitstream/10419/298849/1/189126494X.pdf
    Download Restriction: no
    File URL: https://libkey.io/10.4419/96973257?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
    ---><---

    References listed on IDEAS

    as
    1. Katrin Zocher, 2024. "Exiting primary care providers," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 1033-1054, May.
    2. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    3. Kirill Borusyak & Xavier Jaravel & Jann Spiess, 2024. "Revisiting Event-Study Designs: Robust and Efficient Estimation," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 91(6), pages 3253-3285.
    4. Zhang, Xuan, 2022. "The effects of physician retirement on patient outcomes: Anticipation and disruption," Journal of Public Economics, Elsevier, vol. 207(C).
    5. Wiebke Schuettig & Leonie Sundmacher, 2022. "The impact of ambulatory care spending, continuity and processes of care on ambulatory care sensitive hospitalizations," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1329-1340, November.
    6. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    7. 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).
    8. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    9. 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).
    10. 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).
    11. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    12. 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.
    Full references (including those not matched with items on IDEAS)

    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. Daniel Monsees & Matthias Westphal, 2025. "The Effects of Resigning GPs on Patient Healthcare Utilization and Some Implications for Health," Health Economics, John Wiley & Sons, Ltd., vol. 34(5), pages 932-955, May.
    2. 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).
    3. Politzer, Eran, 2025. "A change of plans: Switching costs in the procurement of health insurance," Journal of Health Economics, Elsevier, vol. 102(C).
    4. Sabety, Adrienne, 2023. "The value of relationships in healthcare," Journal of Public Economics, Elsevier, vol. 225(C).
    5. Kyunghoon Ban & D'esir'e K'edagni, 2022. "Robust Difference-in-differences Models," Papers 2211.06710, arXiv.org, revised Aug 2023.
    6. Hahm, Dong Woo, 2026. "From curriculum to career: Early-career labor market effects of the Common Core," Economics of Education Review, Elsevier, vol. 110(C).
    7. Fabra, Natalia & Gutiérrez, Eduardo & Lacuesta, Aitor & Ramos, Roberto, 2024. "Do renewable energy investments create local jobs?," Journal of Public Economics, Elsevier, vol. 239(C).
    8. Dalia Ghanem & Pedro H. C. Sant'Anna & Kaspar Wüthrich, 2022. "Selection and Parallel Trends," CESifo Working Paper Series 9910, CESifo.
    9. Schindler, Yannick & Scott, Andrew J., 2025. "The macroeconomic impact of chronic disease in the United Kingdom," The Journal of the Economics of Ageing, Elsevier, vol. 32(C).
    10. Xiaoyong Dai & Peichao Guo, 2026. "Policy failure in public support for small business innovation: the case of innovation vouchers in China," Small Business Economics, Springer, vol. 66(1), pages 393-421, January.
    11. Tatsuru Kikuchi, 2025. "A Unified Framework for Spatial and Temporal Treatment Effect Boundaries: Theory and Identification," Papers 2510.00754, arXiv.org, revised Oct 2025.
    12. Lennon, Conor & Maclean, Johanna Catherine & Teltser, Keith, 2025. "Ridesharing and substance use disorder treatment," Journal of Health Economics, Elsevier, vol. 99(C).
    13. Brehm, Johannes & Pestel, Nico & Schaffner, Sandra & Schmitz, Laura, 2025. "From Low Emission Zone to academic track: Environmental policy effects on educational achievement in elementary school," Journal of Environmental Economics and Management, Elsevier, vol. 132(C).
    14. Guillaume Gueguen & Claudia Senik, 2023. "Adopting telework: The causal impact of working from home on subjective well‐being," British Journal of Industrial Relations, London School of Economics, vol. 61(4), pages 832-868, December.
    15. Artunç, Cihan & Saleh, Mohamed, 2026. "Connected national capital: Corporations in colonial and independent Egypt," Journal of Development Economics, Elsevier, vol. 180(C).
    16. Coraggio, Luca & Pagano, Marco & Scognamiglio, Annalisa & Tåg, Joacim, 2025. "JAQ of all trades: Job mismatch, firm productivity and managerial quality," Journal of Financial Economics, Elsevier, vol. 164(C).
    17. Burton, Anne M. & Churchill, Brandyn F., 2025. "Supply-side opioid restrictions and the retail pharmacy market," Journal of Health Economics, Elsevier, vol. 104(C).
    18. Martin Huber & Sarina Joy Oberhansli, 2026. "Difference-in-differences for mediation analysis using double machine learning," Papers 2602.23877, arXiv.org.
    19. Katrin Zocher, 2024. "Exiting primary care providers," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 1033-1054, May.
    20. Rojas, Alexandra & Palmqvist, Carl-William & Camporeale, Rosalia, 2026. "The socioeconomic impact of train stations: evidence from a 20-year study in Sweden," Transportation Research Part A: Policy and Practice, Elsevier, vol. 204(C).

    More about this item

    Keywords

    ;
    ;
    ;
    ;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:zbw:rwirep:298849. 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: ZBW - Leibniz Information Centre for Economics (email available below). General contact details of provider: https://edirc.repec.org/data/rwiesde.html .

    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.