Effect of a copayment on use of the emergency department in a health maintenance organization
Effect of a copayment on use of the emergency department in a health maintenance organization
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DOI：
10.1056/nejm199603073341006
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发表时间：
1996-03-07
影响因子：
158.5
通讯作者：
Swain, BE
中科院分区：
文献类型：
--
作者：
Selby, JV;Fireman, BH;Swain, BE
背景。使用急诊科进行非紧急护理是频繁和昂贵的。我们研究了一组模式的健康维护组织（HMO）的共同支付对急诊科使用的影响。我们调查了1992年和1993年使用急诊科的30276名受试者，他们在研究开始时年龄从1岁到63岁不等，属于北加州凯撒永久医疗组织。我们评估了他们对各种HMO服务的使用情况，以及他们在引入使用急诊科共付25至35美元的费用之前和之后的临床结果。该共同支付组与两个随机选择的不受共同支付影响的对照组进行比较。对照组有60,408名成员，他们的年龄、性别和居住地区与共同支付组相匹配。第二组有37,539名会员，根据这些因素和雇主类型进行匹配。在对1992年的年龄、性别、社会经济地位和急诊科使用情况进行调整后，1993年共付组就诊次数的下降幅度比两组对照组大14.6个百分点
Background. Use of the emergency department for nonemergency care is frequent and costly. We studied the effect of a copayment on emergency department use in a group-model health maintenance organization (HMO).Methods. We examined the use of the emergency department in 1992 and 1993 by 30,276 subjects who ranged in age from 1 to 63 years at the start of the study and belonged to the Kaiser Permanente HMO in northern California. We assessed their use of various HMO services and their clinical outcomes before and after the introduction of a copayment of $25 to $35 for using the emergency department. This copayment group was compared with two randomly selected control groups not affected by the copayment. One control group, with 60,408 members, was matched for age, sex, and area of residence to the copayment group. The second, with 37,539 members, was matched for these factors and also for the type of employer.Results. After adjustment for age, sex, socioeconomic status, and use of the emergency department in 1992, the decline in the number of visits in 1993 was 14.6 percentage points greater in the copayment group than in either control group (P