Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners

Do out-of-hours general practitioner services and emergency departments cost more by collaborating or by working separately? A cost analysis

Sjoerd Broekman 1 , Elisabeth Van Gils-Van Rooij 2 , Berthold Meijboom 2 , Dingenus De Bakker 1 2 , Christoffel Yzermans 1
+ Author Affiliations
- Author Affiliations

1 Netherlands Institute for Health Services Research, The Netherlands

2 Tilburg University Tranzo Scientific Centre for Care and Welfare, Tilburg, The Netherlands

Correspondence to: Sjoerd Broekman, Netherlands Institute for Health Services Research, 3513CR, Utrecht, The Netherlands. Email:

Journal of Primary Health Care 9(3) 212-219
Published: 25 September 2017

Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


INTRODUCTION: In the Netherlands, general practitioners (GPs) and emergency departments (EDs) collaborate increasingly in urgent care collaborations (UCCs) in which the two services share one combined entrance and joint triage.

AIM: The objective of this study is to determine if UCCs are cost-effective compared to the usual care setting where out-of-hours GP services and EDs work separately.

METHODS: This observational study compared UCCs with the usual care setting on costs by performing linear regression analyses. These costs were also combined with two performance indicators: level of patient satisfaction and the length of stay. A non-parametric bootstrap (resampling) method was performed in order to analyze the cost-effect pairs.

RESULTS: During the study period, 122,061 patients visited EDs and the out-of-hours GP services. Total mean costs per episode were substantially higher in UCCs: ?480 versus ?392 respectively. In this study, two factors that contributed to higher costs in UCCs compared to usual care were identified. First, there was a higher proportion of GP consultations instead of cheaper medical advice for self-care in UCCs. Second, in UCCs there were more often double costs per episode, as more patients were referred to an ED after triage or consulting GP services. The cost-effectiveness analyses show that UCCs were not dominant on cost-effectiveness compared to the usual care setting.

DISCUSSION: A substitution of, often self-referring, patients from EDs to GP services does not result in lower costs to society, a shorter length of stay or a higher level of patient satisfaction.

KEYWORDS: Urgent Care Collaboration; GP services; ED visits; costs


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