在医疗补助计划中,急诊室是否被用作初级保健的替代品或补充品?
Alina Denham1, Elaine L Hill2, Maria Raven3
1Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA.
Health economics, policy, and law
|October 23, 2023
概括
旨在减少急诊室 (ED) 访问的政策可能不如预期那么有效. 调查结果表明,对于一些医疗补助患者来说,ED补充而不是取代初级保健 (PC),特别是在城市地区.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
背景情况:
- 减少低急性急诊室 (ED) 使用的传统政策假设ED取代初级保健 (PC).
- 如果患者使用ED来补充PC,这种假设可能是有缺陷的,可能会加剧ED过度拥挤.
- 了解ED和PC使用之间的关系对于有效的医疗保健政策至关重要.
研究的目的:
- 调查医疗补助管理护理入学者是否使用ED作为初级保健 (PC) 的替代品或补充.
- 分析初级保健供应对低急性急诊室访问的影响.
- 根据地理因素和PC提供商的类型,研究这种关系是如何不同的.
主要方法:
- 利用纽约全州规划和研究合作系统 (SPARCS) 的门诊数据,从2012年至2015年.
- 采用消费者选择理论框架和非线性最小平方回归.
- 模拟县级月度ED访问率作为PC供应的函数,比较Medicaid扩张之前和之后的时期.
主要成果:
- 在医疗补助扩张后 (2014-2015年),ED和PC在全州充当了替代品.
- 然而,ED和PC在高度城市化和较贫穷的县里是互补的,特别是在夜晚和周末.
- 在医疗补助扩张 (2012-2013) 之前,没有发现互补的证据.
结论:
- 减少低敏度ED使用的政策应该考虑ED的补充作用,特别是在城市和服务不足的地区.
- 建议增加实际预约的可用性,特别是与医生,以改善PC访问并减少不必要的ED访问.
- ED和PC访问之间的关系是复杂的,受提供者类型和地理特征等因素的影响.
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