Public healthcare eligibility and the utilisation of GP services by older people in Ireland

Presenter: Yuanyuan Ma, Trinity College Dublin, Ireland

Author: Anne Nolan

Co-author(s): Yuanyuan Ma

Equity of access to healthcare is regarded as a key objective of national and international health policy. The current Irish system of healthcare financing and public healthcare entitlements is unusual internationally, with the requirement for a large proportion of the population (approximately 60%) to pay the full cost of GP care at the point of use a particular concern. In this paper we focus on the older population, using data from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative survey of the over 50s in Ireland. Using data from the first two Waves of TILDA, and difference-in-difference propensity score matching methods, we describe how respondents’ entitlements to free GP care changed between Wave 1 and Wave 2 of TILDA, and the consequences for GP visiting levels. We find that becoming eligible for free GP visits leads to a significant increase in GP visiting, and that becoming eligible for GP user fees (i.e., losing eligibility for free GP care) leads to a significant decrease in GP visiting. By comparing the magnitudes of the effects, we find that the change in GP visiting is larger for those losing public healthcare eligibility than for those gaining public healthcare eligibility, suggesting that the deterrent effect of user fees is greater than the incentive effect of free GP visits. This research is particularly timely given the commitments in the current Irish Programme for Government, whereby free GP care for the entire population is to be introduced on a phased basis.