Substituting emergency services: primary care vs. hospital care

Area of Science:

• Health Services Research
• Public Health Policy
• Health Economics

Background:

• Emergency department (ED) overcrowding is a significant issue in healthcare systems, leading to inefficiencies.
• Inappropriate ED visits, where primary care could suffice, contribute to this overcrowding.
• Germany's healthcare system lacks a strict gate-keeping mechanism, potentially exacerbating ED overcrowding.

Purpose of the Study:

• To quantify the substitutability between primary care emergency services (PCES) and emergency department (ED) utilization in Germany.
• To identify determinants influencing the extent of substitution between PCES and ambulatory ED visits, and inpatient ED admissions.
• To provide policy-relevant insights for managing ED overcrowding by understanding patient diversion patterns.

Main Methods:

• Utilized extensive longitudinal data from Germany.
• Employed fixed effects models to analyze the relationships.
• Incorporated interaction terms to explore the influence of various determinants on substitution.

Main Results:

• Demonstrated significant substitution between PCES and ambulatory ED visits.
• Found that substitution is strongest for younger, better-educated patients, and when hospital EDs are more accessible.
• Identified a significant, but considerably smaller (eight times less), substitution for inpatient ED admissions, particularly for non-urgent, short-stay cases and elderly patients.

Conclusions:

• Ambulatory ED visits are a notable substitute for PCES, with specific demographic and accessibility factors influencing this substitution.
• Inpatient ED admissions show a lesser degree of substitutability with PCES.
• Findings offer valuable data for policymakers in non-gatekeeping systems to design interventions promoting PCES utilization and alleviating ED overcrowding.