The Distributional Effects of Primary Care Reform in Austria: Patient Selection, Social Inclusion, and Equity-Sensitive Outcomes in Primary Health Care Units

Austria's Primary Care Act 2017 introduced Primary Health Care Units (PHCUs) to strengthen multidisciplinary, community-based care. Although better access to primary care is associated with improved health outcomes, socioeconomic inequalities persist in universal systems. Access often remains inversely related to need, raising concerns that reforms may improve average access without reducing, or even widening, inequalities. Causal evidence on PHCU effects in Austria remains limited. The project examines whether PHCUs reduce, maintain, or exacerbate socioeconomic gradients in healthcare access, utilisation, and outcomes. It investigates (i) differences in patient composition between PHCUs and GP practices, (ii) changes in regional utilisation inequalities around PHCU rollout, and (iii) causal effects of PHCU availability on utilisation and outcomes, including heterogeneity across the socioeconomic status. The analysis uses linked individual-level administrative data on healthcare utilisation, employment, earnings, and sociodemographic characteristics. The empirical strategy combines descriptive analyses of patient selection, concentration indices to measure socioeconomic inequalities, and causal inference using staggered difference-in-differences and a differential-distance instrumental variable design. A Primary Care Research Network will serve as an advisory board, informing interpretation and policy-relevant outputs. The project delivers (1) a characterisation of PHCU patient populations, (2) evidence on how utilisation inequalities evolve with PHCU rollout, (3) causal estimates of PHCU effects on utilisation and outcomes, including heterogeneous effects across the SES distribution, and (4) regional primary care profiles incorporating socioeconomic information.