IDEAS home Printed from https://ideas.repec.org/p/bol/bodewp/wp978.html
   My bibliography  Save this paper

Does the extension of primary care practice opening hours reduce the use of emergency services?

Author

Listed:
  • M. Lippi Bruni
  • I. Mammi
  • C. Ugolini

Abstract

Over-crowding in Emergency Departments (EDs) generates potential inefficiencies. Using regional administrative data, we investigate the impact of an increase in the accessibility of primary care on ED visits in Italy. We test whether extending practice opening hours up to 12 hours/day reduces inappropriate ED visits. We estimate count data models, considering different measures for ED visits recorded at the list level. Since the extension programme is voluntary, we also account for the potential endogeneity of participation, using a two-stage residual inclusion and a GMM approach. Our results show that improving primary care accessibility favours a more appropriate use of EDs.

Suggested Citation

  • M. Lippi Bruni & I. Mammi & C. Ugolini, 2014. "Does the extension of primary care practice opening hours reduce the use of emergency services?," Working Papers wp978, Dipartimento Scienze Economiche, Universita' di Bologna.
    • Handle: RePEc:bol:bodewp:wp978
    as

    Download full text from publisher

    File URL: http://amsacta.unibo.it/4109/1/WP978.pdf
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Cameron,A. Colin & Trivedi,Pravin K., 2013. "Regression Analysis of Count Data," Cambridge Books, Cambridge University Press, number 9781107667273, September.
    2. Bernard Fortin & Nicolas Jacquemet & Bruce Shearer, 2010. "Labour Supply, Work Effort and Contract Choice: Theory and Evidence on Physicians," Cahiers de recherche 1034, CIRPEE.
    3. Dolores Jiménez-Rubio & Cristina Hernández-Quevedo, 2011. "Inequalities in the use of health services between immigrants and the native population in Spain: what is driving the differences?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(1), pages 17-28, February.
    4. Propper, Carol & Croxson, Bronwyn & Shearer, Arran, 2002. "Waiting times for hospital admissions: the impact of GP fundholding," Journal of Health Economics, Elsevier, vol. 21(2), pages 227-252, March.
    5. Greene, William, 2007. "Functional Form and Heterogeneity in Models for Count Data," Foundations and Trends(R) in Econometrics, now publishers, vol. 1(2), pages 113-218, August.
    6. Fattore, Giovanni & Frosini, Francesca & Salvatore, Domenico & Tozzi, Valeria, 2009. "Social network analysis in primary care: The impact of interactions on prescribing behaviour," Health Policy, Elsevier, vol. 92(2-3), pages 141-148, October.
    7. Dusheiko, Mark & Gravelle, Hugh & Martin, Stephen & Rice, Nigel & Smith, Peter C., 2011. "Does better disease management in primary care reduce hospital costs? Evidence from English primary care," Journal of Health Economics, Elsevier, vol. 30(5), pages 919-932.
    8. Paolo Cremonesi & Enrico Bella & Marcello Montefiori & Luca Persico, 2015. "The Robustness and Effectiveness of the Triage System at Times of Overcrowding and the Extra Costs due to Inappropriate Use of Emergency Departments," Applied Health Economics and Health Policy, Springer, vol. 13(5), pages 507-514, October.
    9. Chan, Chien-Lung & Lin, Wender & Yang, Nan-Ping & Huang, Hsin-Tsung, 2013. "The association between the availability of ambulatory care and non-emergency treatment in emergency medicine departments: A comprehensive and nationwide validation," Health Policy, Elsevier, vol. 110(2), pages 271-279.
    10. Gianluca Fiorentini & Elisa Iezzi & Matteo Lippi Bruni & Cristina Ugolini, 2011. "Incentives in primary care and their impact on potentially avoidable hospital admissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(4), pages 297-309, August.
    11. Gourieroux, Christian & Monfort, Alain & Renault, Eric & Trognon, Alain, 1987. "Generalised residuals," Journal of Econometrics, Elsevier, vol. 34(1-2), pages 5-32.
    12. Mundlak, Yair, 1978. "On the Pooling of Time Series and Cross Section Data," Econometrica, Econometric Society, vol. 46(1), pages 69-85, January.
    13. Jaume Puig‐Junoy & Marc Saez & Esther Martínez‐García, 1998. "Why do patients prefer hospital emergency visits? A nested multinomial logit analysis for patient‐initiated contacts," Health Care Management Science, Springer, vol. 1(1), pages 39-52, September.
    14. Smith, Richard J & Blundell, Richard W, 1986. "An Exogeneity Test for a Simultaneous Equation Tobit Model with an Application to Labor Supply," Econometrica, Econometric Society, vol. 54(3), pages 679-685, May.
    15. Lega, Federico & Mengoni, Alessandro, 2008. "Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications," Health Policy, Elsevier, vol. 88(2-3), pages 326-338, December.
    16. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    17. John Mullahy, 1997. "Instrumental-Variable Estimation Of Count Data Models: Applications To Models Of Cigarette Smoking Behavior," The Review of Economics and Statistics, MIT Press, vol. 79(4), pages 586-593, November.
    18. Lindsay M. Sabik & Sabina Ohri Gandhi, 2016. "Copayments and Emergency Department Use Among Adult Medicaid Enrollees," Health Economics, John Wiley & Sons, Ltd., vol. 25(5), pages 529-542, May.
    19. Hausman, Jerry, 2015. "Specification tests in econometrics," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 38(2), pages 112-134.
    20. Mark Dusheiko & Hugh Gravelle & Stephen Martin & Nigel Rice & Peter C Smith, 2011. "Does Better Disease Management in Primary Care Reduce Hospital Costs?," Working Papers 065cherp, Centre for Health Economics, University of York.
    21. Terza, Joseph V. & Basu, Anirban & Rathouz, Paul J., 2008. "Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling," Journal of Health Economics, Elsevier, vol. 27(3), pages 531-543, May.
    22. Shah, Nasra M. & Shah, Makhdoom A. & Jaafar, Behbehani, 1996. "Predictors of non-urgent utilization of hospital emergency services in Kuwait," Social Science & Medicine, Elsevier, vol. 42(9), pages 1313-1323, May.
    23. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    24. Hausman, Jerry & Hall, Bronwyn H & Griliches, Zvi, 1984. "Econometric Models for Count Data with an Application to the Patents-R&D Relationship," Econometrica, Econometric Society, vol. 52(4), pages 909-938, July.
    25. Roberts, Emilie & Mays, Nicholas, 1998. "Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department?," Health Policy, Elsevier, vol. 44(3), pages 191-214, June.
    26. Fredrik Carlsen & Jostein Grytten & Julie Kjelvik & Irene Skau, 2007. "Better primary physician services lead to fewer hospital admissions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(1), pages 17-24, March.
    27. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
    28. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    29. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    30. Baltagi, Badi H., 2015. "The Oxford Handbook of Panel Data," OUP Catalogue, Oxford University Press, number 9780199940042.
    31. Devlin, Rose Anne & Sarma, Sisira, 2008. "Do physician remuneration schemes matter? The case of Canadian family physicians," Journal of Health Economics, Elsevier, vol. 27(5), pages 1168-1181, September.
    32. Dusheiko, Mark & Gravelle, Hugh & Jacobs, Rowena & Smith, Peter, 2006. "The effect of financial incentives on gatekeeping doctors: Evidence from a natural experiment," Journal of Health Economics, Elsevier, vol. 25(3), pages 449-478, May.
    33. Thomas E Cowling & Elizabeth V Cecil & Michael A Soljak & John Tayu Lee & Christopher Millett & Azeem Majeed & Robert M Wachter & Matthew J Harris, 2013. "Access to Primary Care and Visits to Emergency Departments in England: A Cross-Sectional, Population-Based Study," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-6, June.
    34. Windmeijer, F A G & Silva, J M C Santos, 1997. "Endogeneity in Count Data Models: An Application to Demand for Health Care," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 281-294, May-June.
    35. Chamberlain, Gary, 1982. "Multivariate regression models for panel data," Journal of Econometrics, Elsevier, vol. 18(1), pages 5-46, January.
    36. Marta Ameri & Paolo Cremonesi & Marcello Montefiori, 2011. "The Effects of Inappropriate Emercency Department Use," STUDI ECONOMICI, FrancoAngeli Editore, vol. 2011(105), pages 123-136.
    37. A. Colin Cameron & Douglas L. Miller, 2015. "A Practitioner’s Guide to Cluster-Robust Inference," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 317-372.
    38. Lee, Albert & Lau, Fei-Lung & Hazlett, Clarke B. & Kam, Chak-Wah & Wong, Patrick & Wong, Tai-Wai & Chow, Susan, 2000. "Factors associated with non-urgent utilization of Accident and Emergency services: a case-control study in Hong Kong," Social Science & Medicine, Elsevier, vol. 51(7), pages 1075-1085, October.
    39. Moulton, Brent R., 1986. "Random group effects and the precision of regression estimates," Journal of Econometrics, Elsevier, vol. 32(3), pages 385-397, August.
    40. Grytten, Jostein & Sorensen, Rune, 2001. "Type of contract and supplier-induced demand for primary physicians in Norway," Journal of Health Economics, Elsevier, vol. 20(3), pages 379-393, May.
    41. Moulton, Brent R, 1990. "An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit," The Review of Economics and Statistics, MIT Press, vol. 72(2), pages 334-338, May.
    42. Rivers, Douglas & Vuong, Quang H., 1988. "Limited information estimators and exogeneity tests for simultaneous probit models," Journal of Econometrics, Elsevier, vol. 39(3), pages 347-366, November.
    43. Lancaster, Tony, 2000. "The incidental parameter problem since 1948," Journal of Econometrics, Elsevier, vol. 95(2), pages 391-413, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Donatini A. & Fiorentini G. & Lippi Bruni M. & Mammi I. & Ugolini C., 2014. "Dealing with minor illnesses: the link between primary care characteristics and First Aid Clinics attendances," Working Papers wp925, Dipartimento Scienze Economiche, Universita' di Bologna.
    2. Ugolini, Cristina & Lippi Bruni, Matteo & Mammi, Irene & Donatini, Andrea & Fiorentini, Gianluca, 2016. "Dealing with minor illnesses: The link between primary care characteristics and Walk-in Centres’ attendances," Health Policy, Elsevier, vol. 120(1), pages 72-80.
    3. Hongxiu Li, 2017. "Innovation as Adaptation to Natural Disasters," Working Papers 1709, University of Waterloo, Department of Economics, revised Nov 2017.
    4. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    5. Wooldridge, Jeffrey M., 2014. "Quasi-maximum likelihood estimation and testing for nonlinear models with endogenous explanatory variables," Journal of Econometrics, Elsevier, vol. 182(1), pages 226-234.
    6. Aleksey Oshchepkov & Anna Shirokanova, 2020. "Multilevel Modeling For Economists: Why, When And How," HSE Working papers WP BRP 233/EC/2020, National Research University Higher School of Economics.
    7. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    8. Hansen, Bruce E. & Lee, Seojeong, 2019. "Asymptotic theory for clustered samples," Journal of Econometrics, Elsevier, vol. 210(2), pages 268-290.
    9. Fang Hai & Miller Nolan H. & Rizzo John & Zeckhauser Richard, 2011. "Demanding Customers: Consumerist Patients and Quality of Care," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 11(1), pages 1-51, September.
    10. Geert Dhaene & Koen Jochmans, 2015. "Split-panel Jackknife Estimation of Fixed-effect Models," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 82(3), pages 991-1030.
    11. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2018. "Effects of Market Structure and Patient Choice on Hospital Quality for Planned Patients," School of Economics Discussion Papers 1118, School of Economics, University of Surrey.
    12. Seonho Shin, 2021. "Were they a shock or an opportunity?: The heterogeneous impacts of the 9/11 attacks on refugees as job seekers—a nonlinear multi-level approach," Empirical Economics, Springer, vol. 61(5), pages 2827-2864, November.
    13. Fernández-Val, Iván & Vella, Francis, 2011. "Bias corrections for two-step fixed effects panel data estimators," Journal of Econometrics, Elsevier, vol. 163(2), pages 144-162, August.
    14. Fang, Hai & Eggleston, Karen N. & Rizzo, John A. & Zeckhauser, Richard, 2010. "Female Employment and Fertility in Rural China," Working Paper Series rwp10-011, Harvard University, John F. Kennedy School of Government.
    15. Georges Bresson & Guy Lacroix & Mohammad Arshad Rahman, 2021. "Bayesian panel quantile regression for binary outcomes with correlated random effects: an application on crime recidivism in Canada," Empirical Economics, Springer, vol. 60(1), pages 227-259, January.
    16. Anders Skrondal & Sophia Rabe-Hesketh, 2022. "The Role of Conditional Likelihoods in Latent Variable Modeling," Psychometrika, Springer;The Psychometric Society, vol. 87(3), pages 799-834, September.
    17. Giaccherini, Matilde & Kopinska, Joanna & Palma, Alessandro, 2021. "When particulate matter strikes cities: Social disparities and health costs of air pollution," Journal of Health Economics, Elsevier, vol. 78(C).
    18. David T. Frazier & Eric Renault & Lina Zhang & Xueyan Zhao, 2020. "Weak Identification in Discrete Choice Models," Papers 2011.06753, arXiv.org, revised Jan 2021.
    19. Jourdain C. Lokossou & Hippolyte D. Affognon & Alphonse Singbo & Michel B. Vabi & Ayoni Ogunbayo & Paul Tanzubil & Alcade C. Segnon & Geoffrey Muricho & Haile Desmae & Hakeem Ajeigbe, 2022. "Welfare impacts of improved groundnut varieties adoption and food security implications in the semi-arid areas of West Africa," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 14(3), pages 709-728, June.
    20. Garbero, A. & Marion, P., 2018. "IFAD RESEARCH SERIES 28 - Understanding the dynamics of adoption decisions and their poverty impacts: the case of improved maize seeds in Uganda," IFAD Research Series 280077, International Fund for Agricultural Development (IFAD).

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C31 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models; Quantile Regressions; Social Interaction Models

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bol:bodewp:wp978. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Dipartimento Scienze Economiche, Universita' di Bologna (email available below). General contact details of provider: https://edirc.repec.org/data/sebolit.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.