The Impact of Organizational Boundaries on Healthcare Coordination and Utilization

63 Pages Posted: 7 Dec 2020 Last revised: 1 Jul 2023

See all articles by Leila Agha

Leila Agha

Dartmouth College

Keith M. Marzilli Ericson

Boston University - Markets, Public Policy, and Law; National Bureau of Economic Research (NBER)

Xiaoxi Zhao

Boston University

Date Written: December 2020

Abstract

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

Suggested Citation

Agha, Leila and Ericson, Keith M. Marzilli and Zhao, Xiaoxi, The Impact of Organizational Boundaries on Healthcare Coordination and Utilization (December 2020). NBER Working Paper No. w28179, Available at SSRN: https://ssrn.com/abstract=3743912

Leila Agha (Contact Author)

Dartmouth College

Keith M. Marzilli Ericson

Boston University - Markets, Public Policy, and Law ( email )

Boston, MA
United States

National Bureau of Economic Research (NBER) ( email )

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Xiaoxi Zhao

Boston University

595 Commonwealth Avenue
Boston, MA 02215
United States

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