Date of Award
Doctor of Philosophy (PhD)
Health Care Management & Economics
Lawton R. Burns
Despite substantial focus on continuity of care, recent policy has led to significant patient churn. There is little research, however, on the effects of these discontinuities on physician behavior and patient outcomes, and whether physicians behave differently when anticipating a discontinuity. In this paper, I develop a theory of provider behavior. In theory, a provider must choose whether to spend her time treating an ailment or seeking information to diagnose. The optimal trade-off between seeking information and treating varies with the complexity of the patient, but also varies if there is a stock of information from previous encounters. I test this theory using 10 years of panel data from the Military Health System. In this setting, primary care physicians are pulled from their practices and deployed overseas. Using a stacked difference in differences strategy, I separately identify changes in use of care in an anticipatory period after a provider has been informed of the deployment, and in a post period after the provider has left. I find significant changes in both periods, with specialist visits increasing 15- 30 percent (4-8 percentage points) and emergency department visits increasing 15-18 percent (1.7-2 percentage points).
Schwab, Stephen, "You Had Me At Hello: The Effects Of Disruptions To The Patient-Physician Relationship" (2018). Publicly Accessible Penn Dissertations. 3079.