Emergency care: need for reform from an outpatient perspective

Abstract

Reforms of emergency and after hours care have been on the health policy agenda for years, and continue to remain there in the present government’s program. In order to outline where this originates from, we provide a brief summary of past reform steps and a claims data analysis of ambulatory and inpatient emergency and after hours care. Given that previous reform steps have been triggered by increases in emergency department utilization by low acuity cases that could have been treated by office-based physicians during office hours or in after hours care, we analyze the ambulatory and inpatient claims data in the past decade prior to the pandemic (2010–2019). The result shows increases until 2015. Thereafter, the overall case load in emergency wards has levelled, while outpatient cases in emergency wards have decreased. This effect cannot safely be attributed to elements of demand management such as after hours practices in hospitals and telephone triage that have been implemented since then. The distribution of diagnostic codes in claims data suggests that emergency wards and after hours practices have reached a clear division of labor. A continuous shift of patients in age groups 70+ into ambulatory care in emergency wards suggests that this division of labor needs to be further elaborated. Past legislation has not yet been fully implemented. In particular, it is necessary to decide which triage system emergency wards will need to use to identify low acuity patients for redirection into ambulatory care. We argue that implementation and evaluation of these requirements should be completed before further far reaching reforms are enacted.