The Impact of Organizational Boundaries on Health Care Coordination and Utilization

• 成果类型: Article
• 署名作者: Agha, Leila; Ericson, Keith Marzilli; Zhao, Xiaoxi
• 署名单位: Dartmouth College; National Bureau of Economic Research; Boston University; Boston University
• 刊物名称: AMERICAN ECONOMIC JOURNAL-ECONOMIC POLICY
• ISSN/ISSBN: 1945-7731
• DOI: 10.1257/pol.20200841
• 发表日期: 2023
• 页码: 184-214
• 关键词: physician practice competition; vertical integration; firm boundaries; regional-variations; prices paid; continuity; QUALITY; COSTS; FRAGMENTATION; performance

摘要

We measure organizational concentration-the distribution of a patient's health care across organizations-to examine how firm boundaries affect health care efficiency. First, when patients move to regions where outpatient visits are typically concentrated within a small set of firms, their health care utilization falls. Second, for patients whose primary care providers (PCPs) exit the market, switching to a PCP with 1 standard deviation higher organizational concentration reduces utilization by 21 percent. This finding is robust to controlling for the spread of health care across providers. Increases in organiza- tional concentration predict improvements in diabetes care and are not associated with greater use of emergency department or inpatient care. (JEL D22, D23, D24, I11, J14, R32)