Over a span of four years we studied the number and type of patient contacts with the off-hour emergency service in a municipality in Western Norway. At the start of the period, the service was organised by each municipality, later more municipalities formed a regional service. At the end of the period, a list patient system was introduced.
All contacts from patients as well as activities performed by general practitioners on off-hour emergency duty were registered in four separate periods, from 1999 to 2002.
Simultaneously with shift from a local to a regional system, the proportion of home calls fell from 18% to less than 1%. The implementation of a list patient system combined with a regional system reduced the total number of contacts by 30%. Public expenditure was reduced by 66%.
The combination of a regional off-hour service and a list patient system gives an efficient organisation. The total work-load for doctors is significantly reduced and the quality of medical services improve; financial considerations also support a shift in off-hour emergency service towards regional organisation.