Suruda Anthony, Burns Thomas J, Knight Stacey, Dean J Michael
Intermountain Injury Control Research Center, University of Utah, 615 Arapeen Drive #202, Salt Lake City, Utah 84108, USA.
BMC Health Serv Res. 2005 Apr 13;5(1):29. doi: 10.1186/1472-6963-5-29.
It is estimated that approximately half of emergency department (ED) usage in the U.S. and other developed countries is for non-urgent conditions and that this usage is related to availability, social, and economic factors. We examined pediatric ED usage in a U.S. state with respect to income, health insurance status, types of medical conditions, and whether introduction of managed care affected utilization by Medicaid children.
Emergency department usage rates were calculated from 1996 through 1998 using Utah ED data for children with commercial health insurance, Medicaid, for uninsured children, and by income group estimating neighborhood household income from Zip code of residence. We analyzed usage following the July 1996 transition of Utah Medicaid to managed care.
Children with Medicaid had approximately 50% greater ED utilization rates than children with commercial health insurance or uninsured children. The majority of usage for Medicaid and uninsured children was for non-traumatic conditions. Only 35% of total ED usage was for non-emergent or non-urgent conditions and this was related to both Medicaid and low household income. Children lacking health insurance were more likely to be discharged against medical advice (OR = 2.36, 95% C.I. 1.88-2.96). There was no reduction in Medicaid ED usage following the transition to managed care.
Usage of ED services is related to both health insurance status and income. Children lacking health insurance and Medicaid children have excessive usage for conditions which could be treated in a primary care setting. That managed care does not reduce Medicaid ED usage is consistent with findings of other studies.
据估计，在美国和其他发达国家，急诊科（ED）约一半的就诊是因非紧急情况，且这种就诊情况与可及性、社会和经济因素有关。我们针对美国一个州的儿科急诊就诊情况进行了研究，涉及收入、医疗保险状况、医疗状况类型，以及管理式医疗的引入是否影响了医疗补助儿童的就诊率。
利用犹他州1996年至1998年的急诊数据，计算商业医疗保险儿童、医疗补助儿童、无保险儿童的急诊就诊率，并按收入组根据居住邮政编码估算邻里家庭收入来计算。我们分析了1996年7月犹他州医疗补助转为管理式医疗后的就诊情况。
医疗补助儿童的急诊就诊率比商业医疗保险儿童或无保险儿童高出约50%。医疗补助儿童和无保险儿童的就诊大多是因非创伤性疾病。急诊总就诊中只有35%是因非紧急或非急需情况，这与医疗补助和低家庭收入都有关。未参保儿童更有可能不听从医嘱自行出院（比值比 = 2.36，95%置信区间1.88 - 2.96）。转为管理式医疗后，医疗补助儿童的急诊就诊率并未降低。
急诊服务的使用与医疗保险状况和收入都有关。未参保儿童和医疗补助儿童对于可在初级保健机构治疗的疾病就诊过度。管理式医疗并未降低医疗补助儿童的急诊就诊率，这与其他研究结果一致。
