Provider Continuity and Patient Outcomes

Policy Context

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, while provider discontinuity may reduce preventive care and chronic conditions management. The US setting offers key advantages for research on provider continuity, including 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.

Study Design

This project seeks to understand how provider discontinuity may affect patient health-related behavior and outcomes of provider discontinuity by studying the US insured population, particularly Medicare and Medicaid patients. 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.

Results and Policy Lessons

Preliminary results suggested that provider discontinuity causes patients to reduce office visits for established patients, as expected. They also suggest that provider discontinuity causes patients to increase office visits that are for new patients, but this increase does not fully offset the decrease in office visits for established patients. Researchers will also examine the influence of provider continuity on other medical care, diagnoses, spending, and measures of efficiency.

The study 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 help patients make appointments with specific providers, reduce primary care workforce turnover, inform patients of provider departures, and help patients find new providers.