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Cost containment and quality of life. An experiment in compassion for physicians
B H Warren1, P L Bell, S Isikoff
1Department of Internal Medicine, University of Arizona College of Medicine, Tucson.
Insights
Removing physician gatekeeping for nighttime emergency care did not significantly increase service use or costs for most Medicaid patients. This change benefits children under 6, suggesting a need for more humane managed care policies.
Area of Science:
- Healthcare Management
- Health Services Research
- Emergency Medicine
Background:
- Physician gatekeeping in managed care can restrict patient access to services.
- Nighttime gatekeeping requirements may pose challenges for patients and physicians.
- Previous studies have not fully evaluated the impact of reduced gatekeeping on emergency department utilization and costs.
Purpose of the Study:
- To evaluate the impact of removing physician gatekeeping requirements on emergency department (ED) visits and costs for Medicaid enrollees.
- To assess differential effects across age groups, particularly for young children.
- To inform policy recommendations regarding nighttime managed care practices.
Main Methods:
- A retrospective review of ED visits over a 2-year period.
- Comparison of service use and costs before and after the policy change.
- Analysis focused on Medicaid enrollees, with stratification by age.
Main Results:
- No significant increase in ED use or costs for most Medicaid enrollees after gatekeeping removal.
- A notable increase in service use and costs was observed for children under 6 years old between 10 PM and midnight.
- The findings suggest targeted impacts of gatekeeping policies.
Conclusions:
- Eliminating middle-of-the-night physician gatekeeping requirements is feasible and does not significantly increase overall healthcare costs for most Medicaid patients.
- A more humane and practical approach to managed care gatekeeping is recommended.
- Implementing 24-hour urgent care services can reduce ED costs and improve care for Medicaid patients.
Abstract:
A review of emergency department visits during a 2-year period and before and after the liberation of physicians from a requirement of gatekeeping for some patients during the night showed no significant increases in the use or costs of services to our Medicaid enrollees for all but children under 6 years of age between 10 PM and midnight. We recommend that a more humane and practical view be taken of middle-of-the-night gatekeeping requirements for physicians functioning in managed-care environments. We also suggest, as many hospitals have already learned, that the costs of emergency department services for Medicaid patients can be reduced and that care may be enhanced by the offering of 24-hour urgent care services at or near the emergency department.