Does Increased Access to Primary Care Reduce Consumption of Specialty Care?

Sammanfattning: This study examines the relationship between primary care visits and consumption of inpatient care. There are two hypotheses regarding the impact of primary care on specialty care: the substitution hypothesis and the complementation hypothesis. Using health care data for the population over the age of 65 in Stockholm County, Sweden, this study tests whether primary care has a substitutive effect on inpatient days, cost of inpatient care, emergent inpatient days, emergency room visits, and on avoidable inpatient days. This study also tests whether primary care has a complimentary effect on planned inpatient care. The main findings are that health center visits have a substitutive effect on inpatient days, and that primary care has no complimentary effect on planned inpatient days. The results also indicate that the substitution effect works though the intensive margin rather than the extensive margin, which is consistent with the theory as the substitution hypothesis is thought to be strongest for chronically ill people.