Social Research Division, Economic and Social Research Institute, Dublin, Ireland.
Soc Sci Med. 2011 Oct;73(7):978-85. doi: 10.1016/j.socscimed.2011.06.057. Epub 2011 Jul 23.
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.
在爱尔兰共和国，约 30%的人口（“医疗卡患者”）有权享受免费的全科医生服务。资格主要根据收入状况测试来确定。其余 70%的人口（“私人患者”）必须支付全科医生咨询的全部费用。2001 年 7 月，无论收入如何，所有 70 岁以上的人都有资格获得医疗卡。这种资格的扩大提供了一个自然实验，我们可以通过它来检验获得免费全科医生服务对可避免住院的影响。可避免的住院治疗是指，如果及时有效地获得初级保健服务或在初级保健环境中更适当地治疗，就可以避免的住院治疗。本文使用 1999-2004 年的住院数据，目的是检验 2001 年 7 月以后，70 岁以上人群获得更多的全科医生服务机会是否导致该人群的可避免住院治疗减少的命题。结果表明，虽然 70 岁以上人群的可避免住院治疗在 2001 年后确实有所下降，但 70 岁以下人群的住院治疗也有所下降，这意味着无法确定显著的差异效应。
