Choice of emergency health services: an experimental study

The Portuguese national health service (NHS) is expected to provide safe and high quality care 24 hours a day, seven days a week. Everyday, patients with non-life threatening, short-term illnesses or health problems, for which they need convenient treatment or advice, use emergency care departments at hospitals. It is estimated that about one third could have been treated, or advised elsewhere, mainly in primary care (PC), community pharmacies or the national help phone line. This “inappropriate” use of emergency care departments represents an added cost, and a decreased efficiency for the Portuguese NHS. The literature suggests several explanations, either focusing on the system, or patients. This paper analyses whether a misperception of the severity of the health condition by the patients explain the excess demand. Results show that, in fact, there is an overestimation of the degree of severity of some clinical profiles, and therefore a preference for the use of emergency departments. However, when confronted with the real severity of those clinical profiles, only 50% of the cases change the choice of the emergency department (ED). It can also be derived from the results that socio-demographic characteristics and variables related to experience, with the services, and the clinical profiles are important determinants in the perception of severity of the clinical conditions.