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Speeding up the clinical pathways by accessing emergency departments

Author

Listed:
  • Rosella Levaggi

    (University of Brescia)

  • Marcello Montefiori

    (University of Genoa)

  • Luca Persico

    (University of Genoa)

Abstract

Inappropriate emergency admissions create overcrowding and may reduce the quality of emergency care. In Italy, overcrowding is further exacerbated by patients who use emergency admissions as a shortcut to avoid the general practitioner (GP) gateway. In this paper, we investigate access to emergency departments (EDs) by patients with non-severe medical conditions and their willingness to wait. Population data for ED accesses in Liguria (an Italian administrative region) in 2016 were used to estimate the number of strategic accesses and waiting time elasticities of low-severity patients. Our results show that the practice of using EDs to skip gatekeeping is a serious problem. The percentage of patients who engage in such practice vary from 8.7 to 9.9% of non-urgent patients; they generally prefer to access more specialized hospitals, especially during weekdays, when GPs are available, but hospitals run at full capacity. Strategic patients are usually much younger than average. From a policy point of view, our results show that long waits may discourage “genuine” patients rather than strategic ones. It is necessary to develop a system to improve access to patients mainly requiring specialist care, along with enhancing the management of diagnostic examinations through primary care.

Suggested Citation

  • Rosella Levaggi & Marcello Montefiori & Luca Persico, 2020. "Speeding up the clinical pathways by accessing emergency departments," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 37-44, February.
    • Handle: RePEc:spr:eujhec:v:21:y:2020:i:1:d:10.1007_s10198-019-01107-5
    DOI: 10.1007/s10198-019-01107-5
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    References listed on IDEAS

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    1. Marcello Montefiori & Enrico di Bella & Lucia Leporatti & Paolo Petralia, 2017. "Robustness and Effectiveness of the Triage System in the Pediatric Context," Applied Health Economics and Health Policy, Springer, vol. 15(6), pages 795-803, December.
    2. Lindsay Allen & Janet R. Cummings & Jason Hockenberry, 2019. "Urgent Care Centers and the Demand for Non-Emergent Emergency Department Visits," NBER Working Papers 25428, National Bureau of Economic Research, Inc.
    3. Paolo Cremonesi & Enrico Bella & Marcello Montefiori & Luca Persico, 2015. "The Robustness and Effectiveness of the Triage System at Times of Overcrowding and the Extra Costs due to Inappropriate Use of Emergency Departments," Applied Health Economics and Health Policy, Springer, vol. 13(5), pages 507-514, October.
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    Cited by:

    1. Garrafa, Emirena & Levaggi, Rosella & Miniaci, Raffaele & Paolillo, Ciro, 2020. "When fear backfires: Emergency department accesses during the Covid-19 pandemic," Health Policy, Elsevier, vol. 124(12), pages 1333-1339.

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    More about this item

    Keywords

    Clinical pathway; Emergency department; General practitioner; Inappropriate emergency admission; Specialist care; Strategic patient behavior;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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