Does the Extension of Primary Care Practice Opening Hours Reduce the Use of Emergency Services?

Abstract

Over-crowding in Emergency Departments (EDs) generates potential inefficiencies. Using regional administrative data, we investigate the impact of an increase in the accessibility of primary care on ED visits in Italy. We test whether extending practice opening hours up to 12 hours/day reduces inappropriate ED visits. We estimate count data models, considering different measures for ED visits recorded at the list level.Since the extension programme is voluntary, we also account for the potential endogeneity of participation, using a two-stage residual inclusion and a GMM approach. Our results show that improving primary care accessibility favours a more appropriate use of EDs.

The dynamic interdependence in the demand of primary and emergency secondary care: A hidden Markov approach

“…We find evidence of a substitution effect with an additional PC visit in the previous period reducing present ESC visits by about 12.6 percentage points suggesting a fair scope for intervention to policies aiming at redirecting part of the demand of care from ESC to PC. This is in line with results from other empirical studies identifying the substitution effect from the exogenous variation of a policy reform increasing the capacity and accessibility of PC (Pinchbeck, 2019; Lippi Bruni et al, 2016). The proposed model extends previous studies removing the need of an exogenous source of variation for identifying the model, thus allowing the researcher to test for a substitution effect in any segment of the demand of PC and ESC.…”

“…To deal with these issues, existing empirical applications make use of the exogenous variation in the supply of PC induced by a policy reform over time and across geographical areas. Then, they measure the substitution effect at the level of the GP practice or small geographical area by using a linear panel data model (Dolton & Pathania, 2016; Dusheiko et al, 2011; Fortney et al, 2005; Pinchbeck, 2019; Whittaker et al, 2016) or a Poisson model (Iezzi et al, 2014; Lippi Bruni et al, 2016) and a difference in differences approach, which is corroborated by a propensity score matching or an instrumental variable approach in some applications. These studies find evidence of a substitution effect at the GP practice level, although the patient level substitution effect might be different due to ecological fallacy, and the effect in the total population might be different from the effect in areas targeted by the policy.…”

Spatial effects in hospital expenditures: A district level analysis

“…The system is list‐based, and the choice of the physician can be modified at any time. As for practice organisation, the NHS is experiencing an increase in the creation of formal collaborative professional networks of family physicians to favour information sharing about clinical best practices and substitution in case of absence (Lippi Bruni, Mammi, & Ugolini, ). Moreover, GPs establishing networks may share medical equipment, nursing staff, and premises.…”

Should I Wait or Should I Go? Travelling Versus Waiting for Better Healthcare

“…3 Such feature has also induced the economic literature on the Italian NHS to concentrate on singleregion studies taking advantage of a homogenous institutional setting (e.g. Martini et al, 2014;Amaral-Garcia et al, 2015;Lippi Bruni et al, 2016;Perucca et al, 2019, Barili et al, 2021.…”