Did the expansion of free GP care impact demand for Emergency Department attendances? A difference-in-differences analysis

The removal of co-payments for General Practitioner (GP) services has been shown to increase utilisation of GP care. The introduction of free GP care may also have spillover effects on utilisation of other healthcare such as Emergency Department (ED) services, which often serve as substitutes for primary care, and where co-payments to attend exist for many. In Ireland, out-of-pocket payments are paid by the majority of the population to access GP care, and these costs are amongst the highest in Europe. However, in July 2015 all children in Ireland aged under 6 became eligible for free GP care. Using a large administrative dataset on 413,562 ED attendances between January 2015 and June 2016 we apply a difference-in-differences method, with treatment and control groups differentiated by age, to examine whether ED utilisation changed amongst younger children following the introduction of universal free GP care. In particular, we examine ED attendances following a GP referral, as referrals from GPs also afford access to the ED free of charge. We find that the expansion of free GP care did not reduce overall ED utilisation for under 6s. Additionally, we find that the proportion of ED attendances occurring through GP referrals increased by over 2 percentage points. This latter finding may be indicative of increased pressure placed on GPs from increased demand. Overall, this study finds that expanding free GP care to all young children did not reduce their ED utilisation.