In health systems worldwide, the provider-patient relationship is a central component of healthcare access and production. Provider continuity occurs when a patient is treated by the same provider over time. Provider discontinuity, defined as a break in continuity, could affect the quantity and quality of care. Provider discontinuity may reduce preventive care and chronic conditions management. Patients face search costs (e.g., finding in-network providers) and transaction costs (e.g., transferring medical records) in obtaining new providers, and therefore may delay seeking care. However, on the other hand, some patients could benefit from switching providers by receiving valuable second opinions, which may counteract the negative effects of provider discontinuity.
Understanding the influence of provider continuity—particularly in primary care—will help health systems develop institutional structures, capabilities, and policies to strengthen healthcare delivery and improve public health.
This project studies the US insured population, particularly Medicare and Medicaid insured patients. The US setting offers key advantages for research on provider continuity: due to the high-quality of administrative data, which includes physician and patient information, diagnoses, and medical and prescription drug claims. Like many countries with developing healthcare systems, the US has fragmented healthcare systems in which patients choose physicians and pay substantial out-of-pocket costs. The results will serve as a benchmark for other countries with fragmented healthcare systems (rather than national healthcare systems) and/or two-tier healthcare systems in which patients often use private healthcare providers. Since the US is relatively developed, educated, and technologically advanced, the results could potentially represent best-case outcomes for patients seeking new providers in similar contexts.
The study will estimate causal effects of provider discontinuity on patient health-related behavior and outcomes. Researchers first examine discontinuity events, such as physician exits from the profession, physician relocations, and patient health plan switches that cause their physicians to become out-of-network.
The project then compares discontinuity events to identify the mechanisms that contribute to patient healthcare delays. Furthermore, the project will assess how behavioral mechanisms contribute to delays and underuse in preventive care and chronic conditions management.
Results and Policy Implications
The results will offer insights on ways to improve healthcare access, quality, and efficiency in the provider continuity context. Governments could regulate private health plans, mandate short-term access to out-of-network providers for new health plan enrollees, and reform physician laws. Insurers and employers could offer health plans with less restrictive provider networks. More broadly, health systems could offer patients the option to make appointments with specific providers, reduce primary care workforce turnover, inform patients of provider departures, and help patients find new providers.