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Did the expansion of free GP care impact demand for Emergency Department attendances? A difference-in-differences analysis

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  • Walsh, Brendan
  • Nolan, Anne
  • Brick, Aoife
  • Keegan, Conor

Abstract

The removal of co-payments for General Practitioner (GP) services has been shown to increase utilisation of GP care. The introduction of free GP care may also have spillover effects on utilisation of other healthcare such as Emergency Department (ED) services, which often serve as substitutes for primary care, and where co-payments to attend exist for many. In Ireland, out-of-pocket payments are paid by the majority of the population to access GP care, and these costs are amongst the highest in Europe. However, in July 2015 all children in Ireland aged under 6 became eligible for free GP care. Using a large administrative dataset on 413,562 ED attendances between January 2015 and June 2016 we apply a difference-in-differences method, with treatment and control groups differentiated by age, to examine whether ED utilisation changed amongst younger children following the introduction of universal free GP care. In particular, we examine ED attendances following a GP referral, as referrals from GPs also afford access to the ED free of charge. We find that the expansion of free GP care did not reduce overall ED utilisation for under 6s. Additionally, we find that the proportion of ED attendances occurring through GP referrals increased by over 2 percentage points. This latter finding may be indicative of increased pressure placed on GPs from increased demand. Overall, this study finds that expanding free GP care to all young children did not reduce their ED utilisation.

Suggested Citation

  • 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.
    • Handle: RePEc:eee:socmed:v:222:y:2019:i:c:p:101-111
    DOI: 10.1016/j.socscimed.2018.12.029
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    1. Starfield, Barbara & Shi, Leiyu, 2002. "Policy relevant determinants of health: an international perspective," Health Policy, Elsevier, vol. 60(3), pages 201-218, June.
    2. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    3. Sheelah Connolly & Anne Nolan & Brendan Walsh & Maev-Ann Wren, 2018. "Universal GP Care in Ireland: Potential Cost Implications," The Economic and Social Review, Economic and Social Studies, vol. 49(1), pages 93-109.
    4. Siciliani, Luigi & Moran, Valerie & Borowitz, Michael, 2014. "Measuring and comparing health care waiting times in OECD countries," Health Policy, Elsevier, vol. 118(3), pages 292-303.
    5. Kaestner, Robert & Sasso, Anthony T. Lo, 2015. "Does seeing the doctor more often keep you out of the hospital?," Journal of Health Economics, Elsevier, vol. 39(C), pages 259-272.
    6. Courtemanche, Charles & Friedson, Andrew I. & Rees, Daniel I., 2018. "Ambulance Utilization in New York City after the Implementation of the Affordable Care Act," IZA Discussion Papers 11444, Institute of Labor Economics (IZA).
    7. Nolan, Anne, 2011. "An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment," Social Science & Medicine, Elsevier, vol. 73(7), pages 978-985.
    8. Ann S. O'Malley, 2013. "After-Hours Access to Primary Care Practices Linked with Lower Emergency Department Use and Less Unmet Medical Need," Mathematica Policy Research Reports c42f2f64522c4e5db5d1af94a, Mathematica Policy Research.
    9. Cathy J. Bradley & David Neumark & Lauryn Saxe Walker, 2017. "The Effect of Primary Care Visits on Health Care Utilization: Findings from a Randomized Controlled Trial," NBER Working Papers 24100, National Bureau of Economic Research, Inc.
    10. 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.
    11. 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.
    12. Connolly, Sheelah & Wren, Maev-Ann, 2016. "The 2011 proposal for Universal Health Insurance in Ireland: Potential implications for healthcare expenditure," Health Policy, Elsevier, vol. 120(7), pages 790-796.
    13. Stephen G. Donald & Kevin Lang, 2007. "Inference with Difference-in-Differences and Other Panel Data," The Review of Economics and Statistics, MIT Press, vol. 89(2), pages 221-233, May.
    14. Slawa Rokicki & Jessica Cohen & Gunther Fink & Joshua Salomon & Mary Beth Landrum, 2018. "Inference with difference-in-differences with a small number of groups: a review, simulation study and empirical application using SHARE data," CHaRMS Working Papers 18-01, Centre for HeAlth Research at the Management School (CHaRMS).
    15. A. Colin Cameron & Douglas L. Miller, 2015. "A Practitioner’s Guide to Cluster-Robust Inference," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 317-372.
    16. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, Oxford University Press, vol. 119(1), pages 249-275.
    17. Wren, Maev-Ann & Connolly, Sheelagh & Cunningham, Nathan, 2015. "An Examination of the Potential Costs of Universal Health Insurance in Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS45.
    18. Smith, Samantha, 2007. "Characteristics of Emergency Department Attendances in Four Irish Teaching Hospitals," Papers HRBWP27, Economic and Social Research Institute (ESRI).
    19. Conor Keegan & Aoife Brick & Brendan Walsh & Adele Bergin & James Eighan & Maev‐Ann Wren, 2019. "How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015‐2030," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 569-582, January.
    20. Van den Heede, Koen & Van de Voorde, Carine, 2016. "Interventions to reduce emergency department utilisation: A review of reviews," Health Policy, Elsevier, vol. 120(12), pages 1337-1349.
    21. Camilla Beck Olsen & Hans Olav Melberg, 2018. "Did adolescents in Norway respond to the elimination of copayments for general practitioner services?," Health Economics, John Wiley & Sons, Ltd., vol. 27(7), pages 1120-1130, July.
    22. Nolan, Anne & Layte, Richard, 2017. "The impact of transitions in insurance coverage on GP visiting among children in Ireland," Social Science & Medicine, Elsevier, vol. 180(C), pages 94-100.
    23. Nilsson, Anton & Paul, Alexander, 2018. "Patient cost-sharing, socioeconomic status, and children's health care utilization," Journal of Health Economics, Elsevier, vol. 59(C), pages 109-124.
    24. Colm Harmon & Brian Nolan, 2001. "Health insurance and health services utilization in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 10(2), pages 135-145, March.
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    2. Walsh, Brendan & Wren, Maev-Ann & Smith, Samantha & Lyons, Seán & Eighan, James & Morgenroth, Edgar, 2019. "An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital," Research Series, Economic and Social Research Institute (ESRI), number RS91.

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