The Effect of Primary Care Visits on Health Care Utilization: Findings from a Randomized Controlled Trial
The Effect of Primary Care Visits on Health Care Utilization: Findings from a Randomized Controlled Trial
复制标题
初级保健就诊对医疗保健利用的影响：随机对照试验的结果
DOI：
--
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Lauryn Saxe Walker
中科院分区：
文献类型：
--
作者：
C. Bradley;D. Neumark;Lauryn Saxe Walker
我们进行了一项随机对照试验，招募弗吉尼亚州（美国）的低收入无保险成年人，以确定现金激励是否能有效地鼓励初级保健提供者（PCP）访问，并降低利用率和成本。受试者被随机分为四组：未经治疗的对照组，以及三个激励组之一，在六个月内访问PCP的激励为0美元，25美元或50美元。我们使用实验产生的外源性变异来获得PCP访视影响的因果证据。我们观察到非紧急急诊使用的适度减少和门诊使用的增加，但总成本没有减少。这些调查结果的利用是一致的预期，PCP提供了一种替代急诊科的非紧急情况。总费用没有下降，因为避免急诊所节省的任何费用都被门诊使用率的增加所抵消。
We conducted a randomized controlled trial, enrolling low-income uninsured adults in Virginia (United States), to determine whether cash incentives are effective at encouraging a primary care provider (PCP) visit, and at lowering utilization and costs. Subjects were randomized to four groups: untreated controls, and one of three incentive arms with incentives of $0, $25, or $50 for visiting a PCP within six months of group assignment. We used the exogenous variation generated by the experiment to obtain causal evidence on the effects of a PCP visit. We observed modest reductions in non-urgent emergency department use and increased outpatient use, but no reductions in overall costs. These findings in utilization are consistent with the expectation that PCPs offer an alternative to the emergency department for non-emergent conditions. Total costs did not decline because any savings from avoiding the emergency department were offset by increased outpatient utilization.