National Study of Health Insurance Type and Reasons for Emergency Department Use
National Study of Health Insurance Type and Reasons for Emergency Department Use
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DOI：
10.1007/s11606-013-2734-4
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发表时间：
2014-04-01
影响因子：
5.7
通讯作者：
Ginde, Adit A.
中科院分区：
文献类型：
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作者：
Capp, Roberta;Rooks, Sean P.;Ginde, Adit A.
急诊科（ED）使用率因健康保险类型而异，但健康保险类型与患者报告的寻求急诊科护理的原因之间的关系尚不清楚。我们评估了健康保险类型与从急诊科出院的个体的自我感知敏锐度或获取问题之间的关系。这是2011年全国健康访谈调查的横断面分析。最后一次急诊室就诊未导致住院的成年人（n = 4606）被问及有关寻求急诊室护理原因的结构化问题。我们将反应分类为：1)立即评估的感知需求（视力问题），或2)获得门诊服务的障碍（获取问题）。我们使用多变量逻辑回归模型分析调查加权数据，以检验医疗保险类型与急诊科就诊原因之间的关系，同时调整社会人口统计学特征。总体而言，65.0% （95% CI 63.0-66.9）的成年人报告了每千日元的视力问题，78.9% （95% CI 77.3-80.5）的成年人报告了每千日元的视力问题。在那些报告没有导致最近一次急诊科就诊的视力问题的人中，84.2%报告了每千分之一日元的访问问题。相对于那些有私人保险的人，有医疗补助的成年人（OR 1.05; 95% CI 0.79-1.40）和有医疗保险的成年人（OR 0.98; 95% CI 0.66-1.47）因视力问题而寻求急诊科治疗的可能性相似。拥有医疗补助（OR 1.50; 95% CI 1.06-2.13）和医疗补助+医疗保险（双重资格）（OR 1.94; 95% CI 1.18-3.19）的成年人比拥有私人保险的人更有可能因就医问题寻求急症护理。不同医疗保险类型的出院患者寻求急诊科治疗的原因差异，可能更多地是由于缺乏替代治疗，而不是由于患者感知的视力差异。政策制定者应该把重点放在增加替代性医疗场所的可及性上，特别是医疗补助受益人，以及增加急诊患者和提供者之间的护理协调的策略。
The rates of emergency department (ED) utilization vary substantially by type of health insurance, but the association between health insurance type and patient-reported reasons for seeking ED care is unknown.We evaluated the association between health insurance type and self-perceived acuity or access issues among individuals discharged from the ED.This was a cross-sectional analysis of the 2011 National Health Interview Survey. Adults whose last ED visit did not result in hospitalization (n = 4,606) were asked structured questions about reasons for seeking ED care. We classified responses as 1) perceived need for immediate evaluation (acuity issues), or 2) barriers to accessing outpatient services (access issues).We analyzed survey-weighted data using multivariable logistic regression models to test the association between health insurance type and reasons for ED visits, while adjusting for sociodemographic characteristics.Overall, 65.0 % (95 % CI 63.0-66.9) of adults reported a parts per thousand yen 1 acuity issue and 78.9 % (95 % CI 77.3-80.5) reported a parts per thousand yen 1 access issue. Among those who reported no acuity issue leading to the most recent ED visit, 84.2 % reported a parts per thousand yen 1 access issue. Relative to those with private insurance, adults with Medicaid (OR 1.05; 95 % CI 0.79-1.40) and those with Medicare (OR 0.98; 95 % CI 0.66-1.47) were similarly likely to seek ED care due to an acuity issue. Adults with Medicaid (OR 1.50; 95 % CI 1.06-2.13) and Medicaid + Medicare (dual eligible) (OR 1.94; 95 % CI 1.18-3.19) were more likely than those with private insurance to seek ED care for access issues.Variability in reasons for seeking ED care among discharged patients by health insurance type may be driven more by lack of access to alternate care, rather than by differences in patient-perceived acuity. Policymakers should focus on increasing access to alternate sites of care, particularly for Medicaid beneficiaries, as well as strategies to increase care coordination that involve ED patients and providers.