Excessive use of medical care or rational patient behaviour? A study of a large hospital emergency department

The role of hospital emergency departments has over the years been gradually extended, especially in large urban areas. In Stockholm, visits to hospital emergency departments increased by 30 per cent between 1973 and 1977. The southwestern district, one of Stockholm's five health care districts, has had the highest visiting rates - since 1975 40 per cent above average. A large university hospital, the Huddinge Hospital, was opened in this district in 1972.

The study is an inquiry into the use of the Huddinge Hospital emergency department by the population in its catchment area. The study encompassed not only those who used the emergency department but an approximately 10 per cent sample (17 004 people) of the population. Data was collected from the hospital emergency department, medical records, by interviews with users and non-users and from registers.

During the 15 months' observation (January 1976 to March 1977) 29 per cent of the population visited the hospital emergency department (range for different subareas 22 to 46 per cent). The total number of visits was 566 per 1000 population.

Compared with Swedish citizens, immigrants more often visited the emergency department (19 per cent more visits) but less often used the outpatient clinics. Marked differences between Swedes and immigrants were found in the illness behaviour.

The role of proximity in the use of the hospital emergency department was anlysed by dividing the catchment area into 20 subareas. The subareas closer to the hospital had up to four times higher visiting rates compared with areas further away. The travelling distance to the hospital and the proportion of immigrants together explained 81 per cent of the differences in visiting rates between the subareas.

In one geographically defined subarea, 15 per cent of the population visited district GPs while 30 per cent visited the hospital emergency department. An estimated 39 to 64 per cent of the visits to the hospital emergency department were general practitioner-type cases.

In a representative sample of users and non-users of the emergency department, strong association was found between health status, social factors and the level of use of the emergency department.

The hospital emergency department is a major source of medical care for the population in the catchment area. A considerable part of its diversified role is to compensate for the low capacity of the primary care services in the area.

List of scientific papers

I. Magnusson, G. Utilization of a hospital emergency department in Stockholm. The effects of age, sex and marital status. Scandinavian Journal of Social Medicine. [Accepted]
https://doi.org/10.1177/140349488000800310

II. Magnusson, G. and Aurelius, G. Illness behaviour and nationality: A study of hospital care utilization by immigrants and natives in a Stockholm district. Social Science & Medicine. [Accepted]
https://pubmed.ncbi.nlm.nih.gov/7394578

III. Magnusson, G. The role of proximity in the use of hospital emergency department. Sociology of Health and Illness. [Accepted]
https://doi.org/10.1111/1467-9566.ep10487794

IV. Magnusson, G. The hospital emergency department as the primary source of medical care. Scandinavian Journal of Social Medicine. [Accepted]
https://doi.org/10.1177/140349488000800311

V. Magnusson, G. Association between health status, social factors and level of emergency department use. Medical Care. [Submitted]