An analysis of Medicare and MyHospitals data shows government policies designed to improve access to after hours medical services have reduced pressure on hospital Emergency Departments and deliver lower healthcare costs.
The first-of-its-kind analysis titled ‘Improved Access to After House Services: A Policy Success’ demonstrates that regions with higher use of after hours home visiting services have lower use of hospital emergency departments for low acuity illnesses and deliver services at a lower overall cost.
The co-authors, Dr Umberto Russo, Medical Director at 13 SICK – the National Home Doctor Service, and Ben Keneally, the CEO of National Home Doctor Service, describe how health policy in the early 1990s and late 2000s had improving access to primary health care after hours as a key objective, largely as a response to the significant decline in home visiting by GPs during this period.
The report shows that government policy changes have increased access to after hours care over recent years, with after hours clinic visits and after hours home visits growing at compound annual growth rates of 8% and 12% respectively since 2005/6. As these services have grown, the pressure on EDs has fallen with low acuity presentations growing at only 1% per annum over the last four years.
“The good news is that more Australians now have access to and are using after hours services such as home visiting and after hours clinics. The even better news is that growing use of these services has stopped the growth in low acuity presentations to EDs,” said Dr Russo.
Ben Keneally, CEO of 13 SICK, said: “The growth in home visits is largely thanks to growing awareness, increased bulk billing and increasing availability.”
The report shows that states with higher usage of after hours home visits have lower usage of ED for low acuity presentations, with low acuity ED presentations falling by 0.4 for every additional home visit.
“Given that the average cost to taxpayers of a low acuity Emergency Department presentation is $440 compared to $130 for a bulk billed home visit, this means real savings for taxpayers,” said Mr Keneally.
A wide range of studies suggest that greater use of primary care has the potential to ease pressure on emergency departments. The Productivity Commission has identified that there are 2.2 million GP-type presentations to Emergency Departments annually and that 24% of all Emergency Department patients believe their care could have been carried out by a GP2. Another study3 found that 26% of emergency department visits were due to a lack of alternative care.
Research by National Home Doctor Service shows only 31% of the general public is aware of bulk-billed, after-hours doctor services. To address this, National Home Doctor Service recently launched a new advertising campaign that features GPs recommending the service for patients who need to see a doctor when their regular GP is closed.
Gold Coast versus Central Coast
Dr Russo and Mr Keneally compared the QLD Gold Coast to the NSW Central Coast which have similar demographic profiles, similar geography and access to two major public hospitals. However, the Gold Coast has one of the highest utilisation of after hours services and the Central Coast has a much lower rate, below the average for a metro area.
Residents of the Gold Coast during the winter quarter of 2015 received 82 after hours home visits per 1000 residents compared to only 2 after hours visits per 1000 residents in the Central Coast.
Similarly Gold Coast residents had 104 after hours clinic consults per 1000 compared to only 67 on the Central Coast. However, Central Coast residents were more than two and half times more likely to visit the hospital emergency department for a low acuity issue.
It has been calculated that the cost per citizen of after hours and low acuity Emergency Department services on the Gold Coast is ten per cent lower than on the Central Coast, despite Gold Coast residents having almost twice the level of total access to services.
The other good news to emerge from the case study is that better access to after hours care does not appear to compromise utilisation of daytime GPs, with the regions experiencing almost identical usage of daytime clinic consultations.
Ben Keneally said: “Put simply, this shows that good access to primary healthcare is much less costly than using hospitals.”
“Using reported Medicare expenditure and the national efficient hospital pricing determination, we are able to show that the cost per citizen of these services on the Gold Coast is lower than on the Central Coast, despite Gold Coast residents having almost twice the level of total access to services,” said Ben Keneally.
Mr Keneally said “the results are good news for patients, taxpayers and government.”
“People often want to talk about what isn’t working in our healthcare system, but this is one area that is clearly working.”
