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Substituting emergency services: primary care vs. hospital care.
- Source :
-
Health policy (Amsterdam, Netherlands) [Health Policy] 2019 Nov; Vol. 123 (11), pp. 1053-1060. Date of Electronic Publication: 2019 Aug 24. - Publication Year :
- 2019
-
Abstract
- Overcrowding in emergency departments (EDs) is inefficient, especially if it is caused by inappropriate visits for which primary care physicians could be equally effective as a hospital ED. Our paper investigates the extent to which both ambulatory ED visits and inpatient ED admissions are substitutes for primary care emergency services (PCES) in Germany. We use extensive longitudinal data and fixed effects models. Moreover, we add interaction terms to investigate the influence of various determinants on the strength of the substitution. Our results show significant substitution between PCES and ambulatory ED visits. Regarding the determinants, we find the largest substitution for younger patients. The more accessible the hospital ED is, the significantly larger the substitution. Moreover, substitution is larger among better-educated patients. For inpatient ED admission, we find significant substitution that is eight times smaller than the substitution for ambulatory ED visits. With regard to the determinants, we find the strongest substitution for non-urgent, short-stay admission and elderly patients. Countries with no gate-keeping system (such as Germany) have difficulties redirecting the patients streaming to EDs. Our estimated elasticities can help policy makers to resolve this issue, as our findings indicate where incentivizing the utilization of PCES is particularly effective.<br /> (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Female
Germany
Health Care Surveys
Hospitalization statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Middle Aged
Young Adult
Crowding
Emergency Medical Services supply & distribution
Emergency Service, Hospital organization & administration
Emergency Service, Hospital statistics & numerical data
Primary Health Care organization & administration
Primary Health Care statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1872-6054
- Volume :
- 123
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Health policy (Amsterdam, Netherlands)
- Publication Type :
- Academic Journal
- Accession number :
- 31500837
- Full Text :
- https://doi.org/10.1016/j.healthpol.2019.08.013