Travel distance to the general practitioner. Do patients move closer to the services when starting to use them?1

Objectives The main objectives were 1) to calculate and describe travel time by car from the home of Norwegian residents to the office of their named general practitioner (GP); 2) to estimate changes in travel time for residents who started to visit the GP and, if so, to 3) to explore if the residents changed GP or moved to reduce their travel time. Methods We used nation-wide individual-level annual registry data 2009-2017 on the exact location of the home of every resident and the GP-office to calculate travel time in minutes by car from home to their assigned GP. First, using data for 2017 only, we calculated travel time at the median and 90th percentile, and by sex, age, immigrant background, county of residence and use of GP in 2017. Second, with annual data 2009-2017, and restricting the sample to residents who had not used their GP over the last two years ( t-2 and t-1 ), we used a difference-indifferences model to estimate changes in travel time in the next two years ( t+1 and t+1 ) for patients with a visit in year t compared with those with no visit in t . Separate models were run for those who changed GP and those who moved from t-2 to t ., and for the 20% who lived farthest away in t-1 . Results We could calculate the travel time for 3,976,910 residents in 2017, with a median travel time from home to the GP of 4.9 minutes and a travel time at the 90th percentile of 18.3 minutes. In the most sparsely populated northern county of Norway, travel time was about 5 minutes at the median and below 45 minutes at the 90th percentile. Elderly residents and residents who used their GP in 2017 had a somewhat shorter travel time than other groups of the population. Using annual data for 2009-2017 in the difference-in-differences analysis (16,388,151 resident-year observations), travel time dropped by 2.5 minutes (95% confidence interval 2.4 to 2.6) in t+1 and t+2 for patients with a visit in t compared with similar patients with no visit in t . The drop was similar for patients who did and did not change GP, but larger for patients who moved (10.0 minutes; 95%CI 9.7 to 10.4) compared with those who did not move (0.6 minutes; 95%CI 0.5 to 0.7), and particularly large for the 20% living farthest away in t-1 (24.2 minutes; 95%CI 23.3 to 25.2). Conclusions Travel time from home to ones GP is short for the vast majority of the population in the sparsely populated country of Norway. However, residents move closer to the GP when they start using the services, especially patients who used to live far away. This relocation may reflect strong preferences for proximity to the services, and we conclude that more knowledge is needed to enable transparent balancing of costs and benefits of centralizing GP-services, at least in rural areas. JEL classification I10, E32, J6 ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This paper has received funding from the Research Council of Norway (grant #256678) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the South-East Regional Committees for Medical Research Ethics in Norway (approval number: 2017/373). The data given was already anonymized, which made it impossible to contact or identify any of the patients. For this reason, the same Ethics Committees also waived the need for informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets that support the findings of this study contain sensitive information and are not publicly available due to privacy laws. Individual-level data for research are generally available within Norway upon application conforming with strict regulations and procedures.