Abstract
The progressive ageing of the population and the increasing migration flows are affecting the population structure in most of the western countries. Because of this demographic change, the demand for public services is expected to rise, creating potential problems to the economic sustainability of major public services. Our paper is focused on Accident and Emergency Departments (AEDs) services and it aims at estimating how the AED demand and costs will change adapting to the demographic trend in a specific Italian administrative region (Liguria) in the next decades (2012–2065). This is done as follows: first, we split the patients assisted over a whole year by one of the most relevant Italian AEDs into several categories per severity level (i.e., triage colour) and demographic characteristics (age span, gender, and nationality); using actual accounting data we estimate the average assistance cost per typology of patient; after we derive an estimate of the probability for each category of patient to ask for emergency assistance; finally we use official ISTAT 2012 – 2065 residential population forecasts to provide an estimate of the expected number of accesses per patient category and the overall expected AEDs’ cost of the whole Liguria region. Our results suggest that, although immigration seems to be a more relevant aspect for future AEDs’ sustainability than ageing, the inappropriate use of emergency departments by nonurgent patients is the biggest threat which policymakers will really have to deal with.
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Notes
- 1.
Previous researches show that also non demographic factors [24] can have a role in the determination of future AED sustainability. In particular, medical progress and technology may impact the type and cost of the emergency services offered [14, 33] but these topics exceed the aims of this paper and will not be taken into account in the following.
- 2.
Triage coding is the most common European classification criterion of patients at AED check-in. It is based on four colours, each of them associated to a different severity/urgency patient condition. The most critical patients are classified with a red code and they have to be attended immediately because their life is in peril. Yellow is attributed to urgent patients for which some waiting is possible. Green codes require medical care but it is not urgent. Finally, white codes are nonurgent patients. White code patients and a share of green codes are generally amenable to inappropriate use of AEDs.
- 3.
This analysis is not run directly at regional level as data for the whole Liguria Region are not available to the authors.
- 4.
As E.O. Galliera is not a paediatric hospital and the number of children accessing is small our analysis will be focused only on adults patients (aged more than 14).
- 5.
The analysis is run by episode and not by patient, thus it does not take into account issues connected to re-access of the same individual more than once during the year.
- 6.
Our analysis only include legal resident immigrants without considering illegal immigration.
- 7.
For 14 group categories of foreign people the number of observations in the group was too small (less than 20 units) to allow for inference: thus we approximated average cost for these categories equal to the one of corresponding Italian patients. This is a conservative assumption as foreign individuals tend to have higher average cost for each access.
- 8.
For same reasons cited in note 9, 17 access rates relative to foreign residents were conservatively set equal to the ones of corresponding Italian patients.
- 9.
ISTAT provides three different demographic scenarios, the low, the central and the high, based on different assumptions on the dynamics (projections of) in the number of residents over the period 2012–2065. Our analysis is mainly based on the central scenario, however, estimates using the low and high scenarios are also provided.
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Acknowledgments
The authors would like to thank E.O. Ospedali Galliera for their precious cooperation in providing the data.
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di Bella, E., Cremonesi, P., Leporatti, L., Montefiori, M. (2016). The Impact of Demographic Change on Sustainability of Emergency Departments. In: Di Battista, T., Moreno, E., Racugno, W. (eds) Topics on Methodological and Applied Statistical Inference. Studies in Theoretical and Applied Statistics(). Springer, Cham. https://doi.org/10.1007/978-3-319-44093-4_12
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