Fragmented division of labor and healthcare costs: Evidence from moves across regions
利用美国医保数据，研究发现患者迁往医疗分工更碎片化的地区后，医疗利用率增加10%，且更多使用专科医生、更少接触全科医生，同时高价值与过度使用服务均增加。
Policies aiming to improve healthcare productivity often focus on reducing care fragmentation. Care fragmentation occurs when services are spread across many providers, potentially making coordination difficult. Using Medicare claims data, we analyze the effect of moving to a region with more fragmented care delivery. We find that 60% of regional variation in care fragmentation is independent of patients' individual demand for care and moving to a region with 1 SD higher fragmentation increases care utilization by 10%. When patients move to more fragmented regions, they increase their use of specialists and have fewer encounters with primary care physicians. More fragmented regions have more intensive care provision on many margins, including services sometimes associated with overutilization (hospitalizations, emergency department visits, repeat imaging studies) as well as services associated with high value care (vaccines, guideline concordant for diabetics).