An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment

In the Republic of Ireland, approximately 30 per cent of the population (‘medical card patients’) are entitled to free GP services. Eligibility is determined primarily on the basis of an income means test. The remaining 70 per cent of the population (‘private patients’) must pay the full cost of GP consultations. In July 2001, eligibility for a medical card was extended to all those over 70 years of age, regardless of income. This extension in eligibility provides a natural experiment whereby we can examine the influence of access to free GP services on avoidable hospitalisations. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services or that can be treated more appropriately in a primary care setting. Using hospital discharge data for the period 1999–2004, the purpose of this paper is to test the proposition that enhanced access to GP services for the over 70s after July 2001 led to a decline in avoidable hospitalisations among this group. The results indicate that while avoidable hospitalisations for the over 70s did decline after 2001, they also fell for the under 70s, meaning that a significant difference-in-difference effect could not be identified.

► We examine the impact of an extension in eligibility for free primary care on avoidable hospitalisations in Ireland.
► Avoidable hospitalisations are often used as an indicator of access to primary care services.
► As the policy change affected those aged over 70 years of age only, a difference-in-difference approach was used.
► Using hospital discharge data, we find that avoidable hospitalisations fell for both the treated and control groups.
►  Therefore, a significant difference-in-difference effect could not be detected.