Primary Care Access and Emergency Department Utilization: Theory and Evidence from Canada

We develop a theoretical model to study how after-hours incentives affect emergency department (ED) utilization via changing physician behavior. The model reveals that reductions in ED utilization can only come from patients with conditions severe enough to warrant visiting the ED, yet mild enough to be treatable by their primary care physician. While these incentives induce physicians to work more after hours, they also reduce regular-hours services. Thus, incentivizing physicians to provide after-hours services ambiguously affects ED utilization. Model predictions are tested using administrative data from the province of Ontario, Canada. The data cover visits to physicians’ offices and ED visits from 2004 to 2013, a period with exogenous changes in after-hours incentives. Our findings are consistent with model predictions. We also find that after-hours incentives reduce ED visits, suggesting that our proposed framework may be useful for understanding and even designing after-hours incentives.