Over-50s GP visits increased with free access, report finds

Gaining free access to the family doctor led to an increase in visits among the over-50s but losing a medical or GP visit card had the opposite effect, a report shows.
Over-50s GP visits increased with free access, report finds

The number of medications taken regularly was also impacted by gaining a medical card: the report found usage increased by 16%.

The report ‘Changes in Public Healthcare Entitlement and Healthcare Utilisation among the Older Population in Ireland’ provided “actual proof” that removing financial barriers to accessing healthcare leads to greater usage, according to one of the authors, Dr Patrick Moore. Until now, that argument has been largely “anecdotal”, he said.

What remained unclear, however, was whether additional GP visits or medication use were as a result of actual need or the upshot of simply having a medical card.

“The piece [of the puzzle] we don’t have is why people with medical cards make more visits or use more medication, whether it’s out of necessity or simply availed of because they can,” said Dr Moore, a research fellow with Tilda (The Irish Longitudinal Study on Ageing).

Solving this puzzle would require more detailed, long-term analysis, he said, and Tilda would be able to build up a bigger picture as more data came in over time.

Using data from two waves of Tilda in 2010 and 2012, the report, which will be launched today, found:

  • Over 50s who gained a medical or GP visit card made four instead of three annual visits to the doctor’s surgery, an increase of approximately 43%.
  • Those who lost a card made one visit less, from four per year down to three, equivalent to a fall of approximately 29%.

Of the 7,000 over-50s included in the survey, 458 (12.6%) gained a card and 117 (3.5%) lost out.

Getting a medical card was not, however, associated with any significant changes in the probability of a flu vaccine, the number of emergency department visits, outpatient visits or inpatient nights.

The researchers found that in 2012, 39% of the over 50s had a full medical or GP visit card and no private health insurance (PHI); 18% had dual cover — a full medical or GP visit card and PHI; 33% had PHI only; and 10% had ‘no cover’ — neither a full medical/GP visit card nor PHI.

Dr Anne Nolan, another of the report’s authors, said the findings had “important implications” for policy makers because it gave a taste of what demands on the service will be like if free GP care —already extended to the under-6s and over 70s — is extended to all.

“In the context of extensions in free GP care, it is crucial to understand current patterns of healthcare utilisation, not only for highlighting the extent to which the current system leads to financial barriers to accessing healthcare services, but also for forecasting the likely demand implications of reform proposals so that policymakers can cost the proposals and plan effectively,” Dr Nolan said.

While Fine Gael had pushed the notion of universal healthcare during the lifetime of the last government, the problem of how to fund this model has not been resolved. The special cross-party committee on the Future of Healthcare, set up under the new Government, will examine the steps required to implement universal healthcare, including an appropriate funding model.

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