National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries
National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries
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DOI：
10.1016/j.annemergmed.2012.01.035
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发表时间：
2012-07-01
影响因子：
6.2
通讯作者：
Ginde, Adit A.
中科院分区：
文献类型：
--
作者：
Cheung, Paul T.;Wiler, Jennifer L.;Ginde, Adit A.
研究目的：我们比较医疗补助与私人保险的成年人在及时初级保健和急诊科（ED）利用方面的障碍之间的关系。方法：对1999 ~ 2009年全国健康访谈调查的230258名成人进行分析。我们评估了医疗补助和私人保险受益人及时获得初级保健的5个特定障碍（无法通过电话获得，无法尽快获得预约，在医生办公室等待时间长，诊所时间有限，缺乏交通工具）与急诊科利用率（>=去年1次急诊科就诊）之间的关系。多变量logistic回归模型调整了人口统计学、社会经济地位、健康状况、门诊护理利用和调查年份。结果：总体而言，16.3%的医疗补助受益人和8.9%的私人保险受益人在及时初级保健方面存在大于或等于1个障碍。与拥有私人保险的个人相比，医疗补助受益人的ED使用率总体较高（39.6%对17.7%），特别是那些有障碍的人（51.3%对24.6%，61.2%对28.9%）。在调整协变量后，医疗补助受益人更有可能存在障碍（调整优势比[OR] 1.41； 95%可信区间[Cl] 1.30至1.52）和更高的ED利用率（调整优势比[OR] 1.48； 95%可信区间[Cl] 1.41至1.56）。与有私人保险和障碍的个人相比，有1个障碍的医疗补助受益人（调整后的OR为1.66；95% Cl为1.44至1.92）或大于或等于2个障碍（调整后的OR为2.01；95% Cl为1.72至2.35）的ED利用率更高。结论：与有私人保险的个体相比，医疗补助受益人在及时获得初级保健方面受到更多障碍的影响，并有更高的ED使用率。仅仅扩大医疗补助资格可能不足以改善医疗服务的可及性。[j] .中华医学杂志。2012;30(4):391 - 391。
Study objective: We compare the association between barriers to timely primary care and emergency department (ED) utilization among adults with Medicaid versus private insurance.Methods: We analyzed 230,258 adult participants of the 1999 to 2009 National Health Interview Survey. We evaluated the association between 5 specific barriers to timely primary care (unable to get through on telephone, unable to obtain appointment soon enough, long wait in the physician's office, limited clinic hours, lack of transportation) and ED utilization (>= 1 ED visit during the past year) for Medicaid and private insurance beneficiaries. Multivariable logistic regression models adjusted for demographics, socioeconomic status, health conditions, outpatient care utilization, and survey year.Results: Overall, 16.3% of Medicaid and 8.9% of private insurance beneficiaries had greater than or equal to 1 barrier to timely primary care. Compared with individuals with private insurance, Medicaid beneficiaries had higher ED utilization overall (39.6% versus 17.7%), particularly among those with barriers (51.3% versus 24.6% for 1 barrier and 61.2% versus 28.9% for >= 2 barriers). After adjusting for covariates, Medicaid beneficiaries were more likely to have barriers (adjusted odds ratio [OR] 1.41; 95% confidence interval [Cl] 1.30 to 1.52) and higher ED utilization (adjusted OR 1.48; 95% Cl 1.41 to 1.56). ED utilization was even higher among Medicaid beneficiaries with 1 barrier (adjusted OR 1.66; 95% Cl 1.44 to 1.92) or greater than or equal to 2 barriers (adjusted OR 2.01; 95% Cl 1.72 to 2.35) compared with that for individuals with private insurance and barriers.Conclusion: Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated ED utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access. [Ann Emerg Med. 2012;60:4-10.]