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Models Of Primary Care Organization And The Use Of Emergency Departments

Author

Listed:
  • Álvaro S Almeida

    (CEF.UP and Faculdade de Economia, Universidade do Porto)

  • Joana Vales

    (Centro Hospitalar do Tâmega e Sousa, EPE)

Abstract

Overcrowding in hospitals’ emergency department (ED) has often been attributed to lack of appropriate response in other parts of the health system, namely primary healthcare (PHC) institutions, but there is no definitive evidence supporting this assertion. We use patient-level data of 117,391 ED visits from two non-urban hospitals in Portugal to assess the effect that the model of PHC organization may have on ED utilization. PHC organization for the patients in our sample differed in two dimensions: patients may be enrolled in three different types of functional units - Personalized Healthcare Unit, Family Health Unit (FHU) Type A and B; and patients may have (or not) a specific family physician assigned. We estimate three different models using three dependent variables that describe the use of EDs: inappropriate use, rate of utilization and severity of patients. We conclude that the model of primary care organization exerts a significant influence on the use of EDs. FHUs have a significant positive effect on reducing the rate of utilization and inappropriate attendance of EDs. FHUs also have patients with lower severity conditions. We also conclude that patients with an assigned family physician make more appropriate use of the ED.

Suggested Citation

  • Álvaro S Almeida & Joana Vales, 2017. "Models Of Primary Care Organization And The Use Of Emergency Departments," FEP Working Papers 598, Universidade do Porto, Faculdade de Economia do Porto.
    • Handle: RePEc:por:fepwps:598
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    File URL: http://www.fep.up.pt/investigacao/workingpapers/wp598.pdf
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    References listed on IDEAS

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    1. Rosenblatt, R.A. & Wright, G.E. & Baldwin, L.-M. & Chan, L. & Clitherow, P. & Chen, F.M. & Hart, L.G., 2000. "The effect of the doctor-patient relationship on emergency department use among the elderly," American Journal of Public Health, American Public Health Association, vol. 90(1), pages 97-102.
    2. Pedro Ramos & Alvaro Almeida, 2016. "The Impact of an Increase in User Costs on the Demand for Emergency Services: The Case of Portuguese Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 25(11), pages 1372-1388, November.
    3. Pedro Ramos & Álvaro Almeida, 2014. "The Impact of An Increase in User Costs on the Demand For Emergency Services: The Case of Portuguese Hospitals," FEP Working Papers 531, Universidade do Porto, Faculdade de Economia do Porto.
    4. Grumbach, K. & Keane, D. & Bindman, A., 1993. "Primary care and public emergency department overcrowding," American Journal of Public Health, American Public Health Association, vol. 83(3), pages 372-378.
    5. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    6. Caroline Berchet, 2015. "Emergency Care Services: Trends, Drivers and Interventions to Manage the Demand," OECD Health Working Papers 83, OECD Publishing.
    Full references (including those not matched with items on IDEAS)

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    More about this item

    Keywords

    Overcrowding; Emergency Department; Primary care; family physician;
    All these keywords.

    JEL classification:

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

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