Patients change their behavior and the way they interact with the healthcare system in the face of an economic recession. For example, rising unemployment rates can lead to an increase in the number of individuals without insurance. Healthcare use can also change due to increased financial stress: patients may be more likely to put off healthcare needs that are not immediately pressing, or the stress may lead to changes in mental and physical health.
Providers may also change their behavior in the wake of an economic recession. In a paper published in Medical Care Research and Review, Alice Chen and her colleagues examine changes in service intensity during visits to primary care physicians (PCPs) among Medicare patients during 2006-2012, a period that covers the 2007-2009 Great Recession. Medicare patients provide an interesting look into how physicians change their behavior for a number of reasons. Most importantly, by focusing on the Medicare population, the researchers mitigate some of the patient-induced variation that results from changes in employment.
During the Great Recession Patients with Employer-Sponsored Insurance Reduce their Use of Healthcare Services, Service Intensity for Medicare Patients Increased
Consistent with the literature, the researchers found that visits among privately insured patients decreased. In single-specialty practices, a 1 percentage point increase in unemployment was associated with a 5 percent reduction in privately insured visits.
Meanwhile, an increase in the county unemployment rate of 1 percentage point resulted in a 6.3 percent increase in the likelihood of administering additional diagnostic and screening exams and the likelihood of ordering or providing a laboratory or imaging service increased by 32.5 percent in single-specialty practices in the Medicare population. Multispecialty practices demonstrated increases in the number of electrocardiogram tests prescribed and the number of return appointments scheduled.
Physicians Changed their Service Intensity in Response to the Recession
The researchers note these findings appear to show that primary care providers changed their service intensity as a result of the recession. This may be due to a number of associated factors including a reduction in the number of patients seen which may have allowed for increased flexibility in scheduling and an ability to spend more time with patients during an appointment. Alternatively, the decline in privately insured patients may have significantly reduced the provider’s income. Practitioners may be attempting to recoup some of this loss by providing more services.
The full study can be found at Medical Care Research and Review
Citation: Li, J., Chen, A., Parks, M., Ghosh, A., & Casalino, L. P. (2019). County-Level Unemployment Rates and Service Intensity in Primary Care Physician Offices for Medicare Patients. Medical Care Research and Review, 1077558719872864.