Distance effects on the accessibility to emergency departments in Portugal

Distance patients have to travel has shown to influence demand for several health services. Our work looks at this effect on the utilization of Emergency Departments (ED) in Portugal. We build upon previous works by taking into account both the severity of emergency visits and the type of ED and by including a set of other variables that have shown to influence ED utilization. Overall, we find distance-elasticity for emergency care that ranges from -1 to -2 (a 10% increase in distance to ED results in a 10-20% decrease in ED utilization), with low-severity demand having the highest distance-elasticity and high-severity demand the lowest. We also show that Primary Health Care, and particularly some new typology of health centers in Portugal, negatively affects ED utilization. Our results provide evidence that distance enters in the budget constraints patients face when seeking health care.