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Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening

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  • Dolton, Peter
  • Pathania, Vikram

Abstract

Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is also a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients. The impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.

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  • Dolton, Peter & Pathania, Vikram, 2016. "Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening," Journal of Health Economics, Elsevier, vol. 49(C), pages 193-208.
    • Handle: RePEc:eee:jhecon:v:49:y:2016:i:c:p:193-208
    DOI: 10.1016/j.jhealeco.2016.05.002
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    Cited by:

    1. Mauro Laudicella & Paolo Li Donni, 2022. "The dynamic interdependence in the demand of primary and emergency secondary care: A hidden Markov approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 37(3), pages 521-536, April.
    2. Lisa Meehan & Gail Pacheco & Thomas Schober, 2023. "Basic Reading and Mathematics Skills and the Labour Market Outcomes of Young People: Evidence from PISA and Linked Administrative Data," The Economic Record, The Economic Society of Australia, vol. 99(327), pages 473-491, December.
    3. Matteo Lippi Bruni & Cristina Ugolini & Rossella Verzulli & Anna Caterina Leucci, 2023. "The impact of Community Health Centers on inappropriate use of emergency services," Health Economics, John Wiley & Sons, Ltd., vol. 32(2), pages 375-394, February.
    4. Pak, Anton & Gannon, Brenda & Staib, Andrew, 2020. "Forecasting Waiting Time to Treatment for Emergency Department Patients," OSF Preprints d25se, Center for Open Science.
    5. Hong, Michael & Thind, Amardeep & Zaric, Gregory S. & Sarma, Sisira, 2020. "The impact of improved access to after-hours primary care on emergency department and primary care utilization: A systematic review," Health Policy, Elsevier, vol. 124(8), pages 812-818.
    6. Dormont, Brigitte & Dottin, Alexis, 2024. "Does the opening of an emergency department influence hospital admissions? Evidence from French private hospitals," Social Science & Medicine, Elsevier, vol. 340(C).
    7. Megha Swami & Hugh Gravelle & Anthony Scott & Jenny Williams, 2018. "Hours worked by general practitioners and waiting times for primary care," Health Economics, John Wiley & Sons, Ltd., vol. 27(10), pages 1513-1532, October.
    8. Laudicella, Mauro & Li Donni, Paolo & Prete, Vincenzo, 2024. "Healthcare utilisation by diabetic patients in Denmark: the role of primary care in reducing emergency visits," Health Policy, Elsevier, vol. 145(C).
    9. Swami, Megha & Scott, Anthony, 2021. "Impact of rural workforce incentives on access to GP services in underserved areas: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 281(C).
    10. Peter Congdon, 2017. "Quantile regression for overdispersed count data: a hierarchical method," Journal of Statistical Distributions and Applications, Springer, vol. 4(1), pages 1-19, December.
    11. McDonnell, Thérèse & Nicholson, Emma & Barrett, Michael & Bury, Gerard & Collins, Claire & Cummins, Fergal & Deasy, Conor & Denny, Kevin & De Brún, Aoife & Hensey, Conor & McAuliffe, Eilish, 2021. "Policy of free GP care for children under 6 years: The impact on emergency department attendance," Social Science & Medicine, Elsevier, vol. 279(C).
    12. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, María Deni, 2024. "An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems," IDB Publications (Working Papers) 13433, Inter-American Development Bank.
    13. Eichmeyer, Sarah & Zhang, Jonathan, 2023. "Primary care providers’ influence on opioid use and its adverse consequences," Journal of Public Economics, Elsevier, vol. 217(C).
    14. Boone, Claire E & Celhay, Pablo & Gertler, Paul & Gracner, Tadeja & Rodriguez, Josefina, 2022. "How scheduling systems with automated appointment reminders improve health clinic efficiency," Journal of Health Economics, Elsevier, vol. 82(C).
    15. Walsh, Brendan & Nolan, Anne & Brick, Aoife & Keegan, Conor, 2019. "Did the expansion of free GP care impact demand for Emergency Department attendances? A difference-in-differences analysis," Social Science & Medicine, Elsevier, vol. 222(C), pages 101-111.
    16. Samuel Cole & Duha T. Altindag, 2023. "Managerial turnover in primary care clinics," Economic Inquiry, Western Economic Association International, vol. 61(4), pages 942-964, October.
    17. Francetic, Igor & Meacock, Rachel & Sutton, Matt, 2024. "Free-for-all: Does crowding impact outcomes because hospital emergency departments do not prioritise effectively?," Journal of Health Economics, Elsevier, vol. 95(C).
    18. Wang, Tianyu & Wen, Ke & Gao, Qiuming & Sun, Ruochen, 2023. "Small money, big change: The distributional impact of differentiated doctor's visit fee on healthcare utilization," Social Science & Medicine, Elsevier, vol. 339(C).
    19. David, Guy & Smith-McLallen, Aaron & Ukert, Benjamin, 2019. "The effect of predictive analytics-driven interventions on healthcare utilization," Journal of Health Economics, Elsevier, vol. 64(C), pages 68-79.
    20. Pinchbeck, Edward W., 2019. "Convenient primary care and emergency hospital utilisation," Journal of Health Economics, Elsevier, vol. 68(C).
    21. Behrens, Doris A. & Morgan, Jennifer S. & Krczal, Eva & Harper, Paul R. & Gartner, Daniel, 2023. "Still looking in the wrong place: Literature-based evidence of why patients really attend an emergency department," Socio-Economic Planning Sciences, Elsevier, vol. 90(C).
    22. Krämer, Jonas & Schreyögg, Jonas, 2019. "Substituting emergency services: primary care vs. hospital care," Health Policy, Elsevier, vol. 123(11), pages 1053-1060.
    23. Jonas Krämer & Jonas Schreyögg & Reinhard Busse, 2019. "Classification of hospital admissions into emergency and elective care: a machine learning approach," Health Care Management Science, Springer, vol. 22(1), pages 85-105, March.
    24. Pak, Anton & Gannon, Brenda, 2021. "Do access, quality and cost of general practice affect emergency department use?," Health Policy, Elsevier, vol. 125(4), pages 504-511.

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    More about this item

    Keywords

    Primary care; Physician incentives; NHS; GP; A&E; ER;
    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
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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