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.
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.
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.