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Access to emergency care under TennCare: do patients understand the system?
1Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Annals of Emergency Medicine
|September 1, 1997
Summary
Many TennCare patients struggle to access urgent care, lacking knowledge of primary care physician (PCP) contact requirements and responsibilities. Improved communication and PCP responsiveness are crucial for effective managed care system navigation.
Area of Science:
- Health Services Research
- Managed Care
- Patient Access to Care
Background:
- TennCare, a government-managed health care initiative in Tennessee, aims to replace Medicaid.
- Understanding patient navigation of urgent and emergency care within managed care is essential for system efficiency.
Purpose of the Study:
- To assess patient comprehension of accessing urgent and emergency medical care under the TennCare program.
- To identify barriers and facilitators in TennCare patients' utilization of emergency services.
Main Methods:
- Prospective survey of emergency department (ED) patients enrolled in TennCare.
- Data collected from a convenience sample across two time periods (1994 and 1995) at a university hospital ED.
Main Results:
- A significant percentage of patients did not know their primary care physician (PCP) or had never visited them.
- Awareness of the requirement to contact PCPs before ED visits increased from 32% to 94% between survey periods.
- Many patients experienced unsuccessful attempts to contact PCPs, often due to delayed responses, and were unaware of potential billing responsibilities for non-emergency ED visits.
Conclusions:
- Effective communication strategies are needed to inform TennCare participants about proper system usage.
- Managed care organizations (MCOs) must ensure patients know their responsibilities and how to access PCPs to reduce inappropriate ED use.
- Enhanced PCP responsiveness to patient inquiries is vital for improving access to care within the TennCare system.
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