EFFECT OF THE INTRODUCTION OF A FINANCIAL INCENTIVE FOR FEE-PAYING A-AND-E ATTENDERS TO CONSULT THEIR GENERAL-PRACTITIONER BEFORE ATTENDINGTHE A-AND-E DEPARTMENT

Background. The Health (Out-Patient Charges) Regulations 1994 were des igned to encourage those Irish patients liable for their own health ca re costs to attend their GP before their local Accident and Emergency (A&E) department. Such patients are referred to as General Medical Ser vices (GMS)-ineligible. Prior to the introduction of the regulations i n March 1994, there was a perverse financial incentive for these patie nts to attend directly A&E departments instead of their GP. Objective. The aim was to compare the number of GMS-ineligible patients referred by a GP during the year before and the year after the implementation of the Regulations. Method. This study involved the audit of all new a ttendances to a large A&E department, for 1 year before and after the introduction of the new regulations. The main outcome measures were th e number of new attenders in the subsequent year, the proportion of GM S-ineligible attenders, the proportion of GMS-ineligible attenders ref erred by a GP and the proportion of GMS-ineligible attenders referred by a GP and categorized as having neither critical nor urgent complain ts. Results. The total number of new attenders in the year subsequent to the introduction of the regulations was 45 302, an increase of 4.9% on the previous year's total. The proportion of GMS-ineligible attend ers decreased from 45.3 to 44% (-1.3%; 95% confidence interval (CI)-0. 6 to -1.9). The proportion of GMS-ineligible attenders who were referr ed by a GP increased by 2.4% (95%; CI 1.7-3.1). The proportion of GMS- ineligible attenders, referred by a GP with complaints categorized as neither critical nor urgent, increased by 2.5% (95%; CI 1.8-3.2). Conc lusions. The introduction of the regulations was associated with a sma ll, but statistically significant, reduction in the number of GMS-inel igible patients who attended with non-emergency conditions. The propor tion of GMS-ineligible attenders who were referred by a GP increased b y 2.4% (95%; CI 1.7-3.1). The overall workload of the A&E department w as, however, unaffected. Further evaluation of the effects of this red uction on the health status of patients is required.