Broekman, S., Gils-van Rooij, E. van, Meijboom, B., Bakker, D. de, Yzermans, C.J.
Do out-of-hours general practitioner services and emergency departments cost more by collaborating or by working separately? A cost analysis.
Journal of Primary Health Care, 9 (2017) 3, p. 212-219.
Introduction: 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.

Aim: 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.

Methods: 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.

Results: 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 cost-effectiveness compared to the usual care setting.

Discussion: 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.
(aut. ref.)