No fall in emergency departments use after under-6s charge removed, finds study

Removing the charge for children aged under 6 to visit their family doctor did not reduce their use of emergency departments (EDs), research has found.

The study by the Economic and Social Research Institute (ESRI) found “no statistically significant difference in ED use” among the under-6s after free GP care was expanded to this group in July 2015.

This is despite the fact that many services provided within EDs can also be provided by a GP, so “the introduction of free GP care could be expected to reduce ED visits”, says the research.

The study also looked at whether there were changes in ED visits among this age group following a GP referral, as referrals for this group are free of charge.

It noted an increase of two percentage points, largely in children aged 3-5, and most pronounced at weekends, when out-of-hours GP care is more common and GP services are not provided by the patient’s regular doctor.

The research highlights economic considerations when deciding where to take a sick child for treatment. By attending the family doctor first, the €100 ED fee is reduced to zero.

The report points out that the small increase in GP referrals to EDs — approximately 3,550 per annum — “may indicate increased pressure placed on GPs because of additional demand for care”. However, the increased rate equates to just one extra GP referral per GP per annum.

The authors said their findings “are in accordance with previous research on the older Irish population“ which found that reducing cost barriers for GP care had no impact on the use of EDs.

“That the same results are found amongst younger children... suggests that regardless of age group examined, providing free GP care to all may not necessarily reduce use of ED services,” state the authors.

The study points out that the population benefiting from expanded free GP care “are a more affluent group” with a higher rate of private health insurance, so “any rate of substitutability between GP and ED care may be less pronounced” as those with PHI could also attend private emergency or medical clinics.

In this context, further expansion of free GP care will have little impact on ED use, as the majority of those who gain through the expansion will have private health insurance, says the report.

The researchers used data from the Patient Experience Time dataset, covering over 400,000 ED visits by children between January 2015 and June 2016.

It looked at how ED visits changed for the under-6s compared to a group (children aged 7-15) who were not directly affected by the policy change. The researchers found ED visits in the under-6s group did not reduce relative to the older child group.

The authors of the study conclude that while “universal free GP care considerably reduces the cost burden on patients for GP care” — GP costs in Ireland are among the highest in Europe, averaging €52.50 — their analysis suggests that, “in the short term at least, it may not reduce visits to EDs or alleviate pressure on ED services”.

“Finally, that these increases in GP referrals did not increase the number of children admitted to hospital also suggests that many of these ED visits may have been for minor ailments and potentially avoidable, “ says the research.