Does the shift in initial care provision from general practitioners to emergency departments lead to an increase in costs? : a decomposition analysis with accident claims data

General practitioners (GPs) are expected to provide efficient and effective care and serve as coordinators of subsequent treatment pathways. The recent shift of initial care provision from GPs to emergency departments (EDs) therefore raises concerns of driving up costs. We use claims data from the largest Swiss accident insurer (more than 300,000 cases per year) and decompose the change in long-term health care costs per case between 2008 and 2018 into explaining factors across the full distribution. Contrary to our expectation, we find that the type of initial provider (GPs, specialists or EDs) makes no relevant contribution to changes in costs. What really drives cost growth is the increase in the number of different types of supporting providers involved, such as radiologists or physiotherapists, in particular among patients initially treated by a GP.