RESEARCH

Peer-Reviewed Publications

Recent studies on physician exits suggest that general practitioners (GPs) have an important impact on health care utilization and costs, but the transmission channels – interpersonal discontinuities of care, practice style differences and deterioration in access – are usually not clear. Our objective is to estimate the short-run and long-run impacts of switches in GPs on patients’ health care utilization and costs, while all other factors of the health care setting remain the same. To do this, we collect data on handovers of primary care practices in Switzerland, occurring between 2007 and 2015. We link this data to rich insurance claims to construct a panel dataset of roughly 240,000 patients. Employing a difference-in-difference type framework, we find transitory increases in overall visits and costs, which are likely caused by the entering GP’s initial re-assessment of patients’ health care needs. Additionally, we find long-term increases in specialist health care utilization and ambulatory costs. The latter finding can be explained by changes in practice styles between the exiting GP and her successor, who is typically much younger and more likely to be female. In contrast to the literature on practice closures, we do not find evidence on reduced overall utilization rates. An important lesson for health policy is thus to preserve patients’ access to care in the case of GP exits.

Lay Summary: Link (German) 


This paper investigates the consequences that patients face when their regular general practitioner (GP) closes down her practice, typically due to retirement. We estimate the causal impact of closures on patients’ utilization patterns, health care expenditures, hospitalizations, mortality and health plan choice. Employing a difference-in-difference framework, we find that patients who experience a discontinuity of care persistently adjust their ambulatory utilization pattern by shifting visits away from GPs (-12%) towards specialists (+11%), and hospital outpatient facilities (+6%). In contrast, we find no evidence on adverse health effects as measured by hospitalizations and mortality. The impact on utilization is heterogeneous along several dimensions. In particular, we find geographic disparities between regions with high and low availability of primary care. We also observe that patients with chronic conditions substitute more strongly towards other providers. Our results have potential implications for health policy in at least two dimensions: first, practice closures lead to more fragmented care which may entail inefficiencies, and second, closures deteriorate access to primary care in regions with low physician density.

Ungated previous version: VWI Working Paper 1907, Slides, Video (German)


We estimate premium elasticities in a regulated competition market based on a quasi-exogenous premium increase for young adults in Switzerland. We exploit that individuals born before the turn of the year (‘treatment group’) face a larger increase in premiums than individuals born after the turn of the year (‘control group’). We find that the treatment group is 1.5 times more likely to switch their health plan than the control group. Overall, individuals respond to premium increases by changing the plan type (towards more managed care plans), increasing the deductible, and by switching the insurer. Regarding health plan choice, we find an average elasticity of -0.56 with regard to the relative premium difference of any plan to the status quo contract. The elasticity is up to five times larger for the treated (-1.03) than for the controls (-0.19). Our results are not driven by health status as measured by health care expenditures and chronic conditions. Rather, our findings suggest that only salient price increases induce behavior changes in health plan choice. We argue that this finding is of high relevance for health care policies that aim at fostering health plan competition. Ungated previous version (HEDG Working Paper 1716)

Work in Progress and Working Papers

We study the role of inattention as a key source of inertia in health plan choices. Our structural model shows that more than 90% of the elderly in Switzerland are inattentive and thus stick to their previous plan. We estimate sizeable switching costs even conditional on attention explaining part of the observed choice persistence. Inattention leads to overspending and generates considerable welfare losses for most consumers. A policy simulation shows that eliminating financially dominated plans from the choice set yields welfare gains for two thirds of individuals.

VWI Working Paper 2111