Lippi Bruni Matteo, Mammi Irene, Ugolini Cristina
Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126 Bologna, Italy.
Department of Economics, University of Bologna, Piazza Scaravilli 2, 40126 Bologna, Italy.
J Health Econ. 2016 Dec;50:144-155. doi: 10.1016/j.jhealeco.2016.09.011. Epub 2016 Oct 8.
Overcrowding in emergency departments generates potential inefficiencies. Using regional administrative data, we investigate the impact that an increase in the accessibility of primary care has on emergency visits in Italy. We consider two measures of avoidable emergency visits recorded at list level for each General Practitioner. We test whether extending practices' opening hours to up to 12 hours/day reduces the inappropriate utilization of emergency services. Since subscribing to the extension program is voluntary, we account for the potential endogeneity of participation in a count model for emergency admissions in two ways: first, we use a two-stage residual inclusion approach. Then we exploit panel methods on data covering a three-year period, thus accounting directly for individual heterogeneity. Our results show that increasing primary care accessibility acts as a restraint on the inappropriate use of emergency departments. The estimated effect is in the range of a 10-15% reduction in inappropriate admissions.
急诊科人满为患会产生潜在的低效率。我们利用区域行政数据，研究了意大利初级保健可及性的提高对急诊就诊的影响。我们考虑了针对每位全科医生在列表级别记录的两种可避免急诊就诊的衡量指标。我们测试将诊所营业时间延长至每天12小时是否会减少急诊服务的不当使用。由于参与延长计划是自愿的，我们通过两种方式在急诊入院计数模型中考虑参与的潜在内生性：第一，我们使用两阶段残差纳入法。然后，我们对涵盖三年期的数据采用面板方法，从而直接考虑个体异质性。我们的结果表明，提高初级保健可及性对急诊科的不当使用起到了抑制作用。估计效果是不当入院减少10 - 15%。
