Does quality affect choice of family physician? Evidence from patients changing general practice without changing address

Abstract

We examine whether quality affects the choice of practice by patients who are most likely to be well informed about quality: those who leave their practice and join another local practice without changing their address (non-movers). Using 2006/7–2010/11 data on 6766 English practices we estimate fixed effects panel count data models of the number of non-movers leaving a practice and of the number joining. Fewer non-movers leave a practice after increases in clinical quality, the proportion of patients satisfied with access, doctors per patient, and the proportion of doctors qualified in the UK. More join after increases in patient satisfaction with access and doctors per patient. A 10% increase in opening hours satisfaction is associated with a 5.75% reduction in non-movers leaving and a 2.9% increase in non-movers joining. Our results imply that improving information on quality will increase practice incentives to raise quality when competing for patients.