Working Paper: NBER ID: w23078
Authors: Leila Agha; Brigham Frandsen; James B. Rebitzer
Abstract: Policies aiming to improve healthcare productivity often focus on reducing care fragmentation. Care fragmentation occurs when services are spread across many providers, potentially making coordination difficult. Using Medicare claims data, we analyze the effect of moving to a region with more fragmented care delivery. We find that 60% of regional variation in care fragmentation is independent of patients' individual demand for care and moving to a region with 1 SD higher fragmentation increases care utilization by 10%. When patients move to more fragmented regions, they increase their use of specialists and have fewer encounters with primary care physicians. More fragmented regions have more intensive care provision on many margins, including services sometimes associated with overutilization (hospitalizations, emergency department visits, repeat imaging studies) as well as services associated with high value care (vaccines, guideline concordant for diabetics).
Keywords: healthcare; fragmentation; Medicare; utilization
JEL Codes: D20; I10
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| moving to a region with higher care fragmentation (R23) | increased care utilization (I11) |
| increased care utilization (I11) | higher use of specialists (I11) |
| increased care utilization (I11) | fewer encounters with primary care physicians (I11) |
| moving to a region with higher care fragmentation (R23) | higher hospitalizations (I19) |
| moving to a region with higher care fragmentation (R23) | higher emergency department visits (I19) |