Competition and Physician Turnover: Evidence from Swedish Primary Care Units

Sammanfattning: The Swedish government has over the years implemented several reforms to improve health care system and ensure continuity of care. One of the reforms, The Act on Free Choice, was implemented between 2007 and 2010 providing patients a free choice to choose a provider and private providers to freely enter the market; thereby, increasing the competition among providers. This paper contributes to the limited body of literature on competition and continuity of care by exploring the effect of increased competition on physician turnover in Swedish primary care units in following regions, Stockholm, Västra Götaland and Skåne, using a staggered difference-in-difference strategy applied with Two-Way Fixed Effects and stacked regression models. This paper also provides a survival analysis to explore the tenure of primary care physicians and which types of primary care units accounts for the physician turnover using the Cox Proportional Hazard and Kaplan-Meier models. Although the effect of increased competition on physician turnover, on an aggregated level across all regions, is modest, we observe significant effect on a regional basis where the regions respond differently to distances. Results from our survival analysis reveal several factors related to physicians and primary care units that influence physician turnover. Notably, younger physicians graduating from a Swedish medical school account for higher turnover. Moreover, primary care units employing eight or more physicians, and having a lower average age among physicians account for lower physician turnover.