Did the expansion of free GP care impact demand for emergency department attendances? A difference-in-differences analysis. ESRI Research Bulletin 2019/01

We investigate whether the introduction of universal free General Practitioner (GP) care for children aged under 6 reduced visits by this group to Emergency Departments (EDs). In July 2015 all children in Ireland aged under 6 became eligible for free GP care. The number of those aged 0-5 years eligible for free GP care increased from 124,000 in December 2014 to 248,000 by December 2016, with over 90% of GPs with a General Medical Services (GMS) contract quickly signing up to provide free GP care to this group. Previous studies have shown that removing co-payments for GP services increases GP visit rates in both adults and children. As many services provided within EDs can also be provided by a GP, the introduction of free GP care could be expected to reduce of ED visits. This is especially true for those without a medical card, or a referral from a GP, who must pay €100 for each ED visit. We also examine whether there were changes in ED visits following a GP referral, as referrals to EDs from GPs are free of charge.