Center for Regional Economic Development (CRED)

Location dynamics and regional economic policy 

Core competence: Regional health policy

The Swiss healthcare system is highly decentralised, with the cantons playing a key role. Together with the municipalities, they are responsible, among other things, for providing sufficient and economically affordable medical and nursing care. The cantons control the acute care sector on the basis of Article 39 of the Swiss Federal Health Insurance Act (KVG) by means of hospital planning and lists for the admission of hospitals to ordinary health and nursing care insurance. Its purpose is to contain costs or avoid overcapacity. 

We are currently dealing with two aspects of regional health policy: First, we analyse regionally varying trends in the closure of GP surgeries, which have far-reaching consequences for the affected regions as well as for the entire health system. Secondly, we are investigating regional variations in the prescription of so-called “low value” treatments (e.g. vitamin D tests) and generic drugs.

Physician retirement, practice closures and discontinuity of care - What are the causal impacts on patients?

This project, financed through the NRP 74, exploits practice closures to estimate the causal impacts of discontinuities of primary care on patients’ utilization patterns, medical expenditures, and health-related outcomes. Employing a difference-in-difference framework, we identify causal effects by comparing changes in outcomes between an affected group of patients and an unaffected group that does not experience changes in primary care provision.

Grafik 1: Veränderung in der regionalen Verfügbarkeit von medizinischer Grundversorgung zwischen 2005 und 2015.

Our main findings are twofold. First, when faced with a discontinuity of primary care, patients adjust their utilization pattern by shifting visits away from ambulatory primary care providers (-12%) towards specialized care (+11%), and emergent consultations (+5%). This amounts to 18 consultations with GPs per 100 patients, of which 7 are substituted with specialist visits and 2 by outpatient hospital visits. Half of the lost visits are not substituted. Overall costs are not affected, but costs per visit increase by 5%. There is a large regional variation in this pattern. In regions with low GP density, 75% of all lost GP visits are not replaced, while in regions with high GP density this fraction is only 17%. Two policy-relevant implications are that practice closures may lead to an inefficient use of healthcare services and may have longer term adverse effects on public health.

Current projects

Working title Research question
Physician retirement, practice closures, and discontinuity of care - how does it affect patients’ healthcare utilization and health-related outcomes? (NFP 74) What effects does the closure of GP practices have on patients and the healthcare system? Michael Gerfin, Tamara Bischof, Boris Kaiser (B.S.S, Basel)
On the impact of social comparison on physician behavior – A large-scale field xxperiment based on the regional variation in the provision of low- and high-value services How large is the regional variation in the use of low-value care and generic prescription rate? Can this behavior be affected by sending social comparison letters, i.e., can physician behavior be changed by providing best practice information? Tobias Müller, Michael Gerfin