Nonurgent Patients’ Preferences for Emergency Department Versus General Practitioner and Effects of Incentives: A Discrete Choice Experiment

Objective. This study investigates potential of a new financial incentive policy, the GP-referral discount scheme introduced in Singapore, in reducing nonurgent emergency department (ED) visits, and compares it with alternative interventions. Methods. A discrete choice experiment (DCE) was designed to elicit patients’ preferences for ED and general practitioner (GP) under hypothetical nonurgent medical conditions. Through latent class multinomial logistic regression, choice models were estimated to quantify how patients’ choices are influenced by GP-referral discount, other ED/GP attributes (waiting time, test facilities, and payment), patient demographics, and their perception of severity. The choice models were used to predict uptake of the GP-referral discount scheme and other countermeasures suggested by these models. Results. Survey responses from 849 respondents recruited from a public hospital in Singapore were included in the study. The choice model identified two prominent classes of patients, one of which was highly sensitive to GP-referral discount and the other to test-facility-availability. Patients’ perceptions of severity (“critical” v. “not critical” enough to go to ED directly) were highly significant in influencing preference heterogeneity. Predictive analysis based on the choice model showed that GP-referral discount is more effective when patients visit ED expecting “shorter” waits, as opposed to test-facility provision at GPs and perception-correction measures that showed stronger effects under “longer” expected waits. Conclusions. The new GP-referral financial incentive introduced in Singapore can be effective in reducing nonurgent ED visits, if it reasonably covers the (extra) cost of visiting a GP. It may serve as a complement to test-facility provision at GPs or perception-correction measures, as the financial incentive and the latter two measures appear to influence distinct classes (discount-sensitive and facility-sensitive) of patients.