Effect of the introduction of a financial incentive for fee-paying A&E attenders to consult their general practitioner before attending the A&E department
Source: Family Practice, Volume 14, Number 5, 1 October 1997 , pp. 407-410(4)
Publisher: Oxford University Press
Abstract:Background: The Health (Out-Patient Charges) Regulations 1994 were designed to encourage those Irish patients liable for their own health care costs to attend their GP before their local Accident and Emergency (A&E) department. Such patients are referred to as General Medical Services (GMS)-ineligible. Prior to the introduction of the regulations in March 1994, there was a perverse financial incentive for these patients to attend directly A&E departments instead of their GP.
Objective: The aim was to compare the number of GMS-ineligible patients referred by a GP during the year before and the year after the implementation of the Regulations.
Method: This study involved the audit of all new attendances to a large A&E department for 1 year before and after the introduction of the new regulations. The main outcome measures were the number of new attenders in the subsequent year, the proportion of GMS-ineligible attenders, the proportion of GMS-ineligible attenders referred by a GP and the proportion of GMS-ineligible attenders referred by a GP and categorized as having neither critical nor urgent complaints.
Results: The total number of new attenders in the year subsequent to the introduction of the regulations was 45 301, an increase of 4.9% on the previous year's total. The proportion of GMS-ineligible attenders decreased from 45.3 to 44% (-1.3%; 95% confidence interval (CI) -0.6 to .1.9). The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.4% (95%; CI 1.7-3.1). The proportion of GMS-ineligible attenders, referred by a GP with complaints categorized as neither critical nor urgent, increased by 2.5% (95%; CI 2.8-3.2).
Conclusion: The introduction of the regulations was associated with a small, but statistically significant, reduction in the number of GMS-ineligible patients who attended with non-emergency conditions. The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.5% (95%; CI 1.7-3.1). The overall workload of the A&E department was, however, unaffected. Further evaluation of the effects of this reduction on the health status of patients is required.
Document Type: Original Article
Affiliations: 1: Department of General Practice, Clinical Science Institute, University College Galway, Costello Road, Galway, Ireland 2: Department of Accident and Emergency Medicine, and 3: Department of General Practice, University College Dublin, Coombe Healthcare Centre, Dolphins Barn Street, Dublin 8, Ireland 4: Medical Information Systems, St James's Hospital, Dublin 8, Ireland 5: Department of General Practice, Royal College of Surgeons in Ireland, Mercer's Health Centre, Stephen Street Lower, Dublin 2, Ireland
Publication date: 1997-10-01
- Family Practice is an international journal aimed at practitioners, teachers and researchers in the fields of family medicine, general practice and primary care in both developed and developing countries.