Emergency Department Utilization After the Implementation of Massachusetts Health Reform
Emergency Department Utilization After the Implementation of Massachusetts Health Reform
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DOI：
10.1016/j.annemergmed.2011.02.020
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发表时间：
2011-09-01
影响因子：
6.2
通讯作者：
Landon, Bruce E.
中科院分区：
文献类型：
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作者：
Smulowitz, Peter B.;Lipton, Robert;Landon, Bruce E.
试验目的：马萨诸塞州的医疗保健改革改善了医疗保险的可及性，但改革在多大程度上影响了急诊科（艾德）对可能适合初级保健的疾病的利用尚不清楚。我们的目标是确定卫生改革和艾德使用低severity conditions.Methods之间的关系：我们研究了艾德访问，使用方便的样本，马萨诸塞州的11家医院相同的9个月期间之前和之后的医疗保健改革立法于2006年实施。受医疗改革法影响最大的个人（公共补贴保险产品覆盖的无保险和低收入人群）与不太可能受立法影响的个人（医疗保险或私人保险）进行了比较。我们的主要结果措施是研究人群和对照人群在卫生改革实施前后的总体和低严重度艾德就诊率。公共补贴或无保险患者的低严重程度就诊从该组总就诊的43.8%下降到41.2%（差异=2.6%; 95%置信区间[CI] 2.25%至2.85%），而私人保险和医疗保险患者的低严重程度就诊率从该组总就诊率的35.7%降至34.9（差异=0.8%; 95% CI 0.62%至0.98%），差异中的差异为1.8%（95% CI 1.7%至1.9%）。虽然总体艾德量继续增加，马萨诸塞州卫生改革与低-与不太可能受改革影响的个体的比较人群相比，受卫生改革影响最大的那些人群的严重性访问。我们的研究结果表明，获得医疗保险只是影响ED利用的众多因素之一。
Study objective: Health care reform in Massachusetts improved access to health insurance, but the extent to which reform affected utilization of the emergency department (ED) for conditions potentially amenable to primary care is unclear. Our objective is to determine the relationship between health reform and ED use for low-severity conditions.Methods: We studied ED visits, using a convenience sample of 11 Massachusetts hospitals for identical 9-month periods before and after health care reform legislation was implemented in 2006. Individuals most affected by the health reform law (the uninsured and low-income populations covered by the publicly subsidized insurance products) were compared with individuals unlikely to be affected by the legislation (those with Medicare or private insurance). Our main outcome measure was the rate of overall and low-severity ED visits for the study population and the comparison population during the period before and after health reform implementation.Results: Total visits increased from 424,878 in 2006 to 442,102 in 2008. Low-severity visits among publicly subsidized or uninsured patients decreased from 43.8% to 41.2% of total visits for that group (difference=2.6%; 95% confidence interval [CI] 2.25% to 2.85%), whereas low-severity visits for privately insured and Medicare patients decreased from 35.7% to 34.9% of total visits for that group (difference=0.8%; 95% CI 0.62% to 0.98%), for a difference in differences of 1.8% (95% CI 1.7% to 1.9%).Conclusion: Although overall ED volume continues to increase, Massachusetts health reform was associated with a small but statistically significant decrease in the rate of low-severity visits for those populations most affected by health reform compared with a comparison population of individuals less likely to be affected by the reform. Our findings suggest that access to health insurance is only one of a multitude of factors affecting utilization of the ED. [Ann Emerg Med. 2011;58:225-234.]