Ho P Michael, Rumsfeld John S, Lyons Ella, Every Nathan R, Magid David J
Division of Cardiology, University of Colorado Health Sciences Center, Denver, CO, USA.
Ann Emerg Med. 2002 Oct;40(4):381-7.
Previous studies have shown that Medicare patients without supplemental insurance are less likely to receive preventive services, such as mammography. The effect of supplemental insurance on the appropriate use of emergency services is unknown. We sought to determine whether the absence of supplemental Medicare coverage is associated with increased delay in seeking care for acute myocardial infarction.
In this retrospective cohort study, we compared the time from symptom onset to hospital arrival (the time-delay interval) in Medicare patients with and without supplemental insurance coverage who presented with an acute myocardial infarction to 1 of 19 hospitals in King County, WA, from 1989 to 1993. There were 1,373 patients with Medicare-only coverage and 2,050 patients with Medicare plus supplemental insurance coverage.
The age-, sex-, and race-adjusted median time delay was 135 minutes for the Medicare-only group and 130 minutes for the Medicare plus supplemental insurance group (P =.34; 95% confidence interval for median time-delay difference in minutes -5 to 10). There was no significant association between the presence of Medicare supplemental insurance coverage and time delay in Cox regression models, which also adjusted for event year, income, education, past cardiac history, and clinical symptoms.
For this cohort of Medicare patients, the absence of supplemental insurance coverage did not lead to significantly increased delays in seeking care for myocardial infarction. Lack of supplemental insurance for Medicare patients might not have as great an effect on the use of emergency services as it has on other health care services.
以往研究表明，没有补充保险的医疗保险患者接受预防性服务（如乳房X光检查）的可能性较小。补充保险对合理使用急诊服务的影响尚不清楚。我们试图确定医疗保险补充 coverage 的缺失是否与急性心肌梗死就诊延迟增加有关。
在这项回顾性队列研究中，我们比较了1989年至1993年期间在华盛顿州金县19家医院之一就诊的急性心肌梗死医疗保险患者中，有和没有补充保险 coverage 的患者从症状发作到入院的时间（时间延迟间隔）。有1373名仅享有医疗保险 coverage 的患者和2050名享有医疗保险加补充保险 coverage 的患者。
在年龄、性别和种族调整后，仅享有医疗保险组的中位时间延迟为135分钟，医疗保险加补充保险组为130分钟（P = 0.34；分钟中位数延迟差异的95%置信区间为 -5至10）。在Cox回归模型中，医疗保险补充保险 coverage 的存在与时间延迟之间没有显著关联，该模型还对事件年份、收入、教育、既往心脏病史和临床症状进行了调整。
对于这一队列的医疗保险患者，缺乏补充保险 coverage 并未导致心肌梗死就诊延迟显著增加。医疗保险患者缺乏补充保险对急诊服务使用的影响可能不如对其他医疗服务的影响大。
