Policy of free GP care for children under 6 years: The impact on daytime  and out-of-hours general practice

Ireland does not yet have a comprehensive system of universal access to primary care. In 2015, access to general  practitioner (GP) care at no charge was introduced for the 70% of children aged under six who previously paid  out-of-pocket fees. This study uses data from 16 practices and a regional out-of-hours (OOH) GP service to assess  the impact of this policy on attendance.  A difference-in-difference (DiD) analysis was applied to visit records of paediatric patients over a period of five  years, two years of which were pre-policy, with treatment and control differentiated by age.  Attendance at daytime GP by children aged under-six increased by 20%–21% in the three years following the  introduction of the policy, largely explained by an increase in the number of patients attending (17.4%–18.6%).  Of children aged under-six attending pre-policy, 14.9%–15.8% had >6 visits annually, increasing to 18.5%–  20.3% post-policy. OOH GP attendance also increased by 20.5%–29.4% over the same period.  Findings are consistent with international literature on the provision of financially accessible healthcare. Prior  unmet need, the provision of additional assessments to children aged under six, parental response to a service at  no charge, and rerouting of access to the ED through GP, are all possible contributors to this increased demand. A  more integrated policy of boosting supply as well as demand is desirable, particularly in the context of future  expansion plans, to ensure the health benefits anticipated from the introduction of this policy have every opportunity to be realised.