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An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment

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  • Nolan, Anne

Abstract

In the Republic of Ireland, approximately 30 per cent of the population (‘medical card patients’) are entitled to free GP services. Eligibility is determined primarily on the basis of an income means test. The remaining 70 per cent of the population (‘private patients’) must pay the full cost of GP consultations. In July 2001, eligibility for a medical card was extended to all those over 70 years of age, regardless of income. This extension in eligibility provides a natural experiment whereby we can examine the influence of access to free GP services on avoidable hospitalisations. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services or that can be treated more appropriately in a primary care setting. Using hospital discharge data for the period 1999–2004, the purpose of this paper is to test the proposition that enhanced access to GP services for the over 70s after July 2001 led to a decline in avoidable hospitalisations among this group. The results indicate that while avoidable hospitalisations for the over 70s did decline after 2001, they also fell for the under 70s, meaning that a significant difference-in-difference effect could not be identified.

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Bibliographic Info

Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 73 (2011)
Issue (Month): 7 ()
Pages: 978-985

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Handle: RePEc:eee:socmed:v:73:y:2011:i:7:p:978-985

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Related research

Keywords: Avoidable hospitalisation; Primary care; Difference-in-difference; Eligibility; Ireland;

References

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  1. Nolan, Anne, 2008. "Evaluating the impact of eligibility for free care on the use of general practitioner (GP) services: A difference-in-difference matching approach," Social Science & Medicine, Elsevier, vol. 67(7), pages 1164-1172, October.
  2. Layte, Richard & Nolan, Anne & McGee, Hannah & O'Hanlon, Ann, 2009. "Do consultation charges deter general practitioner use among older people? A natural experiment," Social Science & Medicine, Elsevier, vol. 68(8), pages 1432-1438, April.
  3. Richard Layte & Brian Nolan, 2004. "Equity in the Utilisation of Health Care in Ireland," The Economic and Social Review, Economic and Social Studies, vol. 35(2), pages 111–134.
  4. Madden, David & Nolan, Anne & Nolan, Brian, 2004. "GP Reimbursement and Visiting Behaviour in Ireland," Papers HRBWP09, Economic and Social Research Institute (ESRI).
  5. Chiappori, P.A. & Durand, F. & Geoffard, P.Y., 1998. "Moral Hazard and the Demand for Physician Services: First Lessons from a French Natural Experiment," DELTA Working Papers 98-05, DELTA (Ecole normale supérieure).
  6. Nolan, Brian, 1993. "Economic incentives, health status and health services utilisation," Journal of Health Economics, Elsevier, vol. 12(2), pages 151-169, July.
  7. Tussing, A. Dale, 1985. "Irish Medical Care Resources: An Economic Analysis," Research Series, Economic and Social Research Institute (ESRI), number GRS126.
  8. Edward C. Norton & Hua Wang & Chunrong Ai, 2004. "Computing interaction effects and standard errors in logit and probit models," Stata Journal, StataCorp LP, vol. 4(2), pages 154-167, June.
  9. Richard Layte, 2007. "Equity in the Utilisation of Hospital Inpatient Services in Ireland? An Improved Approach to the Measurement of Health Need," The Economic and Social Review, Economic and Social Studies, vol. 38(2), pages 191-210.
  10. Nolan, Brian, 1991. "The Utilisation and Financing of Health Services in Ireland," Research Series, Economic and Social Research Institute (ESRI), number GRS155.
  11. Jacqueline O'Reilly & Miriam M. Wiley, 2008. "How Local is Hospital Treatment? An Exploratory Analysis of Public/Private Variation in Location of Treatment in Irish Acute Public Hospitals," Papers WP237, Economic and Social Research Institute (ESRI).
  12. Dafny, Leemore & Gruber, Jonathan, 2005. "Public insurance and child hospitalizations: access and efficiency effects," Journal of Public Economics, Elsevier, vol. 89(1), pages 109-129, January.
  13. Sergi Jiménez-Mart�n & José M. Labeaga & Maite Mart�nez-Granado, 2002. "Latent class versus two-part models in the demand for physician services across the European Union," Health Economics, John Wiley & Sons, Ltd., vol. 11(4), pages 301-321.
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Cited by:
  1. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.

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