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

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-indifference effect could not be identified.

Which features of primary care affect unscheduled secondary care use? A systematic review

“…One US study showed that poorer access to primary care services increased EHA, but a study in Ireland showed that increasing free primary care to those patients over 70 years of age had no effect on EHA 55 56…”

The impact of rural health system reform on hospitalization rates in the Islamic Republic of Iran: an interrupted time series

“…In a study in Canada, improving access to primary care resulted in a reduction in primary-care-sensitive hospitalizations among the elderly but did not change total hospitalization rates. 33 In Ireland, Nolan et al (2011) observed no changes in avoidable hospitalizations as a result of improved access to primary care. 34 A study conducted in the United States revealed that reductions in the hospitalization rate were not linked to the use of primary care services.…”

“…33 In Ireland, Nolan et al (2011) observed no changes in avoidable hospitalizations as a result of improved access to primary care. 34 A study conducted in the United States revealed that reductions in the hospitalization rate were not linked to the use of primary care services. 35 Saha et al (2007) had hypothesized, like we did, that improving access to primary care -by expanding the Medicaid programme in the state of Oregon in the United States to cover an additional 100 000 low-income families -would result in fewer hospitalizations.…”

The burden of preventable hospitalizations before and after implementation of the health transformation plan in a hospital in west of Iran

“…In a study in Iran, there was no significant difference between the rate of PHs before and after the family physician and rural insurance plan based on the Chi-square test (Salavati and Rashidian, 2017). In another study in Ireland, free access of people to urban family physicians over seventy years did not affect the burden of PHs (Nolan, 2011). However, in a study in Brazil, coverage of the family health plan for PHs had a protective effect (Carvalho et al , 2015).…”