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An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment

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  • Nolan, Anne

Abstract

In the Republic of Ireland, approximately 30 per cent of the population (‘medical card patients’) are entitled to free GP services. Eligibility is determined primarily on the basis of an income means test. The remaining 70 per cent of the population (‘private patients’) must pay the full cost of GP consultations. In July 2001, eligibility for a medical card was extended to all those over 70 years of age, regardless of income. This extension in eligibility provides a natural experiment whereby we can examine the influence of access to free GP services on avoidable hospitalisations. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services or that can be treated more appropriately in a primary care setting. Using hospital discharge data for the period 1999–2004, the purpose of this paper is to test the proposition that enhanced access to GP services for the over 70s after July 2001 led to a decline in avoidable hospitalisations among this group. The results indicate that while avoidable hospitalisations for the over 70s did decline after 2001, they also fell for the under 70s, meaning that a significant difference-in-difference effect could not be identified.

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  • 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.
    • Handle: RePEc:eee:socmed:v:73:y:2011:i:7:p:978-985
    DOI: 10.1016/j.socscimed.2011.06.057
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    References listed on IDEAS

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    16. Richard Layte, 2007. "Equity in the Utilisation of Hospital Inpatient Services in Ireland? An Improved Approach to the Measurement of Health Need," The Economic and Social Review, Economic and Social Studies, vol. 38(2), pages 191-210.
    17. Layte, Richard & Nolan, Anne & McGee, Hannah & O'Hanlon, Ann, 2009. "Do consultation charges deter general practitioner use among older people? A natural experiment," Social Science & Medicine, Elsevier, vol. 68(8), pages 1432-1438, April.
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    1. 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.
    2. Keegan, Conor & Brick, Aoife & García-Rodríguez, Abián & Hill, Leonie, 2022. "Projections of workforce requirements for public acute hospitals in Ireland, 2019–2035: a regional analysis based on the hippocrates model," Research Series, Economic and Social Research Institute (ESRI), number RS147.
    3. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    4. Keane, Claire & Regan, Mark & Walsh, Brendan, 2021. "Failure to take-up public healthcare entitlements: Evidence from the Medical Card system in Ireland," Social Science & Medicine, Elsevier, vol. 281(C).
    5. 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.
    6. Walsh, Brendan & Lyons, Seán, 2021. "Demand for the Statutory Home Care Scheme," Research Series, Economic and Social Research Institute (ESRI), number RS122.
    7. Sofia Vaz & Pedro Ramos, 2016. "Where did civil servants go? the effect of an increase in public co-payments on double insured patients," Health Economics Review, Springer, vol. 6(1), pages 1-8, December.
    8. Keegan, Conor & Brick, Aoife & Bergin, Adele & Wren, Maev-Ann & Whyte, Richard & Henry, Edward, 2020. "Projections of expenditure for public hospitals in Ireland, 2018–2035, based on the Hippocrates Model," Research Series, Economic and Social Research Institute (ESRI), number RS117.
    9. 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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