13 The closure of general practices can lead to regional undersupply and more costly consultations

The project used a dataset of over 200,000 patients who were divided into two groups. The first group included patients who had been affected by the closure of a general practice in the past ten years. The second group involved patients who had not been affected by a practice closure during this period. The number of visits to accident and emergency departments, hospitalization rates, health expenditure and mortality rates have been recorded for both groups over time. The effect of practice closures on the use of medical services, costs and patients’ health was estimated by comparing the data from the two groups and by statistical analysis.

The literature shows that in primary care, a stable doctor-patient relationship is important for patients’ health. In Switzerland, however, this relationship is endangered because a large part of the GPs who are currently practicing will retire in the course of the next years. In rural areas, in particular, it is very hard to find doctors to take over practices, leading to the closure of these practices.

The aim of the study was to examine what effect the closure of general practices have on the use of medical services, costs and patients’ health and which patient groups and regions are particularly affected.

The closure of GP practices led to the loss of 17 consultations with primary care providers per 100 patients (-12%). This reduction was partially offset by consultations with specialists (+7 consultations) and outpatient clinics (+2 consultations), but overall the number of consultations decreased by 8 per 100 patients. In regions with a low physician density, the percentage of consultations in practitioner's offices decreased much more than in regions with a high physician density, which indicates that people in peripheral areas have greater difficulty finding a new GP practice. In regions with a high availability, patients turn to specialists and outpatient clinics much more frequently. The cost per consultation rose by 5 percent, while the total cost remained unchanged due to the reduced number of consultations. This is an indication of increasing inefficiency: on the one hand, consultations are being omitted, while on the other hand, those that continue to take place become more expensive.

Significance of the results for research

This study is the first worldwide to address this specific issue. In this respect, it serves as a basis for follow-up studies. In particular, the question of longer-term health effects is still unresolved.

Significance of the results for practice

The results will help political decision-makers to better assess the consequences of practice closures and take appropriate counter-measures. One goal should be to improve the geographical distribution of family doctors' practices, as is also being sought in other countries.

Physician retirement, practice closures and discontinuity of care: how does it affect patients' healthcare utilization and health-related outcomes?