Effect of practice fees on the use of emergency department services. A before and after study

Abstract

The present study examined differences regarding the following parameters: when did the patient seek emergency department services and how often was inpatient admission necessary. The appropriateness of emergency room utility by patients at two different time points (i.e., before and after introduction of the practice fee) was examined. Finally, an opinion survey of the patient concerning the practice fee was performed. In a bicentric, retrospective, cross-sectional study, the so-called first aid notes of internistic and gynecological emergency department patients of two Berlin maximum care clinics for one month in the years 2001/2002 (t1) and 2006/2007 (t2), respectively, were analyzed. In order to evaluate the appropriateness of utilization, an index of three variables (i.e., transfer to the clinic, diagnostic process, inpatient admission) was compiled. For the data collected in 2006/2007 (t2), a survey of a portion of patients on the effects of the practice fee was undertaken. Significant changes could be shown between t1 and t2 especially in the total frequency of inpatient admissions (45.6% vs. 48.1%, p = 0.024). The probability that women and German female/male patients appropriately visit the emergency department according to the index criteria mentioned above is significantly higher than in men and male patients of Turkish origin/male patients of another ethnic origin. The criteria for appropriate utilization of emergency departments were fulfilled by 20.5% of patients at t1 and 23.7% of patients at t2, a change of 2.2%. The practice fee was generally viewed with criticism by the patients interviewed. It might be that the increase of appropriate utilization is a consequence of the behavior controlling effect of the practice fee. However, patients with an immigrant background showed a clearly lower appropriate utilization of services compared to German patients. This could be due to informative aspects.