NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Causes and Consequences of Fragmented Care Delivery: Theory, Evidence, and Public Policy

Leila Agha, Brigham Frandsen, James B. Rebitzer

NBER Working Paper No. 23078
Issued in January 2017, Revised in April 2017
NBER Program(s):Aging, Health Care, Health Economics, Productivity, Innovation, and Entrepreneurship

Fragmented health care occurs when care is spread out across a large number of poorly coordinated providers. We analyze care fragmentation, an important source of inefficiency in the US healthcare system, by combining an economic model of regional practice styles with an empirical study of Medicare enrollees who move across regions. Roughly sixty percent of cross-regional variation in care fragmentation is independent of patients’ clinical needs or preferences for care. A one standard deviation increase in regional fragmentation is associated with a 10% increase in care utilization. We distinguish between two sources of care fragmentation: primary care fragmentation, where a patient’s care is split across many general practitioners, and specialty fragmentation, where a patient’s care is split across many distinct types of specialists. While both types of fragmentation are associated with higher total utilization, more total visits, and fewer visits with primary care providers, primary care fragmentation also leads to significant increases in hospitalizations. We demonstrate these findings are not explained by regional differences in population density or physician capacity. Applying our model, we identify conditions under which anti-fragmentation policies can improve efficiency.

You may purchase this paper on-line in .pdf format from SSRN.com ($5) for electronic delivery.

Access to NBER Papers

You are eligible for a free download if you are a subscriber, a corporate associate of the NBER, a journalist, an employee of the U.S. federal government with a ".GOV" domain name, or a resident of nearly any developing country or transition economy.

If you usually get free papers at work/university but do not at home, you can either connect to your work VPN or proxy (if any) or elect to have a link to the paper emailed to your work email address below. The email address must be connected to a subscribing college, university, or other subscribing institution. Gmail and other free email addresses will not have access.

E-mail:

A non-technical summary of this paper is available in the 2017 number 2 issue of the NBER Bulletin on Aging and Health. You can sign up to receive the NBER Bulletin on Aging and Health by email.

Machine-readable bibliographic record - MARC, RIS, BibTeX

Document Object Identifier (DOI): 10.3386/w23078

Users who downloaded this paper also downloaded* these:
Acemoglu and Restrepo w23077 Secular Stagnation? The Effect of Aging on Economic Growth in the Age of Automation
Galiani, Staiger, and Torrens w23087 When Children Rule: Parenting in Modern Families
Jaffe and Shepard w23104 Price-Linked Subsidies and Health Insurance Markups
Kyle and Williams w23068 Is American Health Care Uniquely Inefficient? Evidence from Prescription Drugs
Shiller, Waldfogel, and Ryan w23058 Will Ad Blocking Break the Internet?
 
Publications
Activities
Meetings
NBER Videos
Themes
Data
People
About

National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138; 617-868-3900; email: info@nber.org

Contact Us