Why non-urgent patients choose emergency over primary care services? Empirical evidence and managerial implications

Health Policy. 2008 Dec;88(2-3):326-38. doi: 10.1016/j.healthpol.2008.04.005. Epub 2008 May 27.


Objective: To investigate structural and psychological factors that lead non-urgent patients to choose the Accidents & Emergency Department (A&ED) rather than primary care services.

Data sources: Data were collected through interviews by means of a structured questionnaire. Data regarding the A&ED sample were also drawn from the database of the department.

Study design: Hypotheses were tested in a survey comparing A&ED non-urgent patients and patients using GP surgeries. Different perceptions of the characteristics of A&ED and primary care services were measured and a perceptual map was created using the linear discriminant analysis (LDA).

Data collection: Emergency services users were interviewed in the A&ED of the General Hospital of the Province of Macerata (Italy). Primary care users were interviewed in four GP surgeries. 527 patients were interviewed between December 2006 and February 2007.

Principal findings: A&ED and primary care patients look for different characteristics as diagnostic and therapeutic potentialities, empathy and competence, quick access or long-lasting relationship. Information asymmetry explains part of the behaviour.

Conclusions: Use of A&ED services for non-urgent care can be reduced. The understanding of reasons underlying the choice and a change in access, timing and contents of care/services provided by general practitioners (GPs) might provide incentives for shifting from A&ED to GPs surgeries.

MeSH terms

  • Adult
  • Aged
  • Choice Behavior*
  • Emergency Service, Hospital / statistics & numerical data*
  • Empirical Research
  • Female
  • Humans
  • Interviews as Topic
  • Italy
  • Male
  • Middle Aged
  • Patients / psychology
  • Primary Health Care / statistics & numerical data*
  • Young Adult