Primary Care Competition and Quality of Care: Empirical Evidence from Medicare

Abstract

This study explores the effects of primary care physician (PCP) practice competition on ten distinct quality metrics directly tied to screening, follow-up care, and prescribing behavior under Medicare Part B. Using ordered logit with two-stage residual inclusion to account for potential endogeneity between quality and PCP market concentration, this study finds strong evidence that PCP practices in more concentrated markets provide lower quality of care. More specifically, PCPs in more concentrated markets are less likely to perform screening and follow-up care for depression, tobacco use, and unhealthy body weight. Further, PCPs in more concentrated markets have a higher percentage of opioid prescriptions and a higher percentage of Part D beneficiaries with at least one opioid prescription.

Keywords: Primary Care Competition, Quality, Medicare Part B

JEL Classification: I11, L11