Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland.
Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland.
Soc Sci Med. 2019 Feb;222:101-111. doi: 10.1016/j.socscimed.2018.12.029. Epub 2018 Dec 26.
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.
取消全科医生（GP）服务的共付额已被证明会增加 GP 护理的利用率。免费 GP 护理的引入也可能对其他医疗保健的利用率产生溢出效应，例如急诊部（ED）服务，ED 服务通常是初级保健的替代品，而许多 ED 服务都存在共付额。在爱尔兰，大多数人需要支付自付费用才能获得 GP 护理，其费用在欧洲是最高的之一。然而，2015 年 7 月，爱尔兰所有 6 岁以下的儿童都有资格获得免费的 GP 护理。我们使用了一个关于 2015 年 1 月至 2016 年 6 月期间 413562 次 ED 就诊的大型行政数据集，应用了一种差异法，根据年龄将治疗组和对照组区分开来，以检验在引入普遍免费 GP 护理后，年轻儿童的 ED 利用率是否发生了变化。特别是，我们考察了在 GP 转诊后发生的 ED 就诊情况，因为 GP 转诊也可以免费获得 ED 服务。我们发现，扩大免费 GP 护理并没有降低 6 岁以下儿童的整体 ED 利用率。此外，我们发现，通过 GP 转诊发生的 ED 就诊比例增加了超过 2 个百分点。这一发现可能表明，由于需求增加，GP 面临的压力增大。总体而言，本研究发现，为所有年幼的孩子扩大免费 GP 护理并没有降低他们对 ED 的利用率。
