Do out-of-hours GP services and emergency departments cost more by collaborating, or by working separately?

A cost analysis

S.M. Broekman, E.S.J. Gils- van Rooij, B.R. Meijboom, C.J. Yzermans

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in urgent care collaborations (UCCs) in which the two services share one combined entrance and joint triage. The objective of this study is to determine if UCCs are cost-effective compared to the usual care setting where out-of-hours GP services and EDs work separately. This observational study compared UCCs with the usual care setting on costs by
performing linear regression analyses. These costs were also combined with two performance indicators: level of patient satisfaction and the length of stay. A non-parametric bootstrap (resampling) method was performed in order to analyze the cost-effect pairs. During the study period, 122,061 patients visited EDs and the out-of-hours GP services. Total mean costs per episode were substantially higher in UCCs: €480 versus €392 respectively. In this study, two factors that contributed to higher costs in UCCs compared to usual care were identified. First, there was a higher proportion of GP consultations instead of cheaper medical advice for self-care in UCCs. Second, in UCCs there were more often double costs per episode, as more patients were referred to an ED after triage or consulting GP services. The cost-effectiveness analyses show that UCCs were not dominant on costeffectiveness compared to the usual care setting. A substitution of, often self-referring, patients from EDs to GP services does not result in lower costs to society, a shorter length of stay or a higher level of patient satisfaction.
Original languageEnglish
Pages (from-to)212-219
JournalThe Journal of Primary Health Care
Volume9
Issue number3
DOIs
Publication statusPublished - 2017

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General Practitioners
Length of Stay
Netherlands
Cost-Benefit Analysis
Linear Models

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title = "Do out-of-hours GP services and emergency departments cost more by collaborating, or by working separately?: A cost analysis",
abstract = "In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in urgent care collaborations (UCCs) in which the two services share one combined entrance and joint triage. The objective of this study is to determine if UCCs are cost-effective compared to the usual care setting where out-of-hours GP services and EDs work separately. This observational study compared UCCs with the usual care setting on costs byperforming linear regression analyses. These costs were also combined with two performance indicators: level of patient satisfaction and the length of stay. A non-parametric bootstrap (resampling) method was performed in order to analyze the cost-effect pairs. During the study period, 122,061 patients visited EDs and the out-of-hours GP services. Total mean costs per episode were substantially higher in UCCs: €480 versus €392 respectively. In this study, two factors that contributed to higher costs in UCCs compared to usual care were identified. First, there was a higher proportion of GP consultations instead of cheaper medical advice for self-care in UCCs. Second, in UCCs there were more often double costs per episode, as more patients were referred to an ED after triage or consulting GP services. The cost-effectiveness analyses show that UCCs were not dominant on costeffectiveness compared to the usual care setting. A substitution of, often self-referring, patients from EDs to GP services does not result in lower costs to society, a shorter length of stay or a higher level of patient satisfaction.",
author = "S.M. Broekman and {Gils- van Rooij}, E.S.J. and B.R. Meijboom and C.J. Yzermans",
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Do out-of-hours GP services and emergency departments cost more by collaborating, or by working separately? A cost analysis. / Broekman, S.M.; Gils- van Rooij, E.S.J.; Meijboom, B.R.; Yzermans, C.J.

In: The Journal of Primary Health Care, Vol. 9, No. 3, 2017, p. 212-219.

Research output: Contribution to journalArticleScientificpeer-review

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