Continuity of Care Increases Physician Productivity in Primary Care

65 Pages Posted: 7 Sep 2022

See all articles by Harshita Kajaria-Montag

Harshita Kajaria-Montag

University of Cambridge - Judge Business School

Michael Freeman

INSEAD

Stefan Scholtes

University of Cambridge - Judge Business School

Date Written: August 23, 2022

Abstract

Continuity of care, defined as an ongoing therapeutic relationship between a patient and a physician, is a defining characteristic of primary care. However, arranging a consultation with one’s regular doctor is increasingly difficult as practices face physician shortages. We study the effect of declining care continuity on the productivity of physicians by analyzing data of over 10 million consultations in 381 English primary care practices over a period of 11 years. Specifically, we examine whether a consultation with the patient’s regular doctor is more productive than with another doctor in the practice. Using statistical models that account for confounding and selection bias and restricting the sample to consultations with patients who had at least three consultations over the past two years, we find that the time to a patient’s next visit is on average 18.1% (95% CI: [16.9%, 19.2%]) longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration. The data shows that the productivity benefit of care continuity is larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. We estimate that the total consultation demand in our sample could have fallen by up to 5.2% had all practices offered continuity of care at the level of the top decile of practices while prioritizing patients expected to yield the largest productivity benefits. We discuss operational and strategic implications of these findings for primary care practices and for third-party payers.

Note:
Funding Information: Funding for the data was provided by the Cambridge Centre for Health Leadership & Enterprise and INSEAD.

Conflict of Interests: None.

Ethical Approval: This study was approved by the CPRD Independent Scientific Advisory Committee (ISAC) committee. Protocol no.: 19 004R2.

Keywords: Healthcare, Continuity of Care, Productivity, Primary Care

Suggested Citation

Kajaria-Montag, Harshita and Freeman, Michael and Scholtes, Stefan, Continuity of Care Increases Physician Productivity in Primary Care (August 23, 2022). INSEAD Working Paper No. 2022/36/TOM, Available at SSRN: https://ssrn.com/abstract=3868231 or http://dx.doi.org/10.2139/ssrn.3868231

Harshita Kajaria-Montag

University of Cambridge - Judge Business School ( email )

Trumpington Street
Cambridge, CB2 1AG
United Kingdom

Michael Freeman (Contact Author)

INSEAD ( email )

1 Ayer Rajah Avenue
Singapore, 138676
Singapore

Stefan Scholtes

University of Cambridge - Judge Business School ( email )

Trumpington Street
Cambridge, CB2 1AG
United Kingdom

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