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

Anne Nolan1

  • 1Social Research Division, Economic and Social Research Institute, Dublin, Ireland. anne.nolan@esri.ie

Social Science & Medicine (1982)
|August 12, 2011
PubMed

Insights

Extending free GP services to all over 70s in Ireland did not significantly reduce avoidable hospitalizations in this group. While hospitalizations decreased for the over 70s, they also fell for younger populations, negating a clear impact.

Area of Science:

  • Health Economics
  • Public Health Policy
  • Primary Care Research

Background:

  • In Ireland, access to General Practitioner (GP) services is tiered, with 'medical card patients' receiving free care based on income, while 'private patients' incur full costs.
  • A policy change in July 2001 extended medical card eligibility to all individuals aged 70 and over, irrespective of income.
  • This policy shift created a quasi-experimental condition to assess the impact of improved primary care access on healthcare utilization patterns.

Purpose of the Study:

  • To investigate whether the expansion of free GP services to the over-70 population in Ireland led to a reduction in avoidable hospitalizations.
  • To analyze the effect of enhanced primary care access on hospital admission rates for conditions potentially manageable in a primary care setting.

Main Methods:

  • Utilized hospital discharge data covering the period from 1999 to 2004.
  • Employed a difference-in-difference approach to compare changes in avoidable hospitalizations before and after the policy change in July 2001.
  • Focused analysis on the 'over 70s' cohort compared to the 'under 70s' cohort.

Main Results:

  • Avoidable hospitalizations showed a declining trend for the over-70 population following the policy change in 2001.
  • Concurrently, avoidable hospitalizations also decreased among the under-70 population during the same period.
  • The observed parallel trends prevented the identification of a statistically significant difference-in-difference effect attributable to the policy change.

Conclusions:

  • The study did not find conclusive evidence that extending free GP services to all individuals over 70 significantly reduced avoidable hospitalizations in this demographic.
  • The observed decrease in avoidable hospitalizations for the over-70s was mirrored in the younger population, suggesting other unmeasured factors influenced these trends.
  • Further research is needed to explore the complex relationship between primary care access, socioeconomic factors, and hospital admission rates.

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