Ong Eng Hock Marcus, Ornato Joseph P, Cosby Courtney, Franck Thomas
Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, VA 23298-8597, USA.
J Public Health Policy. 2005 Sep;26(3):269-81. doi: 10.1057/palgrave.jphp.3200028.
In the US health care system, a core safety net provider has two defining characteristics: (1) either by legal mandate or explicitly adopted mission, they maintain an "open door," offering patients services regardless of their ability to pay; and (2) a substantial portion of their patients are uninsured, on Medicaid, and/or otherwise vulnerable. The hospital Emergency Department (ED), by all accounts, falls within the definition of a core safety net provider. Yet many would argue that this is a primary health care role for which the ED was not originally intended or equipped. Should the ED be society's health-care safety net? Should it be the main provider of care for the indigent? Is this placing an unbearable strain on the ED? Should it be providing primary health-care? If not, what are the alternatives?
在美国医疗保健系统中,核心安全网提供者有两个决定性特征:(1)无论是依据法律规定还是明确采纳的使命,它们都保持“门户开放”,无论患者支付能力如何,都为其提供服务;(2)其很大一部分患者没有保险、参加医疗补助计划和/或以其他方式处于弱势。无论从哪方面看,医院急诊科都符合核心安全网提供者的定义。然而,许多人会认为,这是急诊科最初并未打算承担或不具备能力承担的初级医疗保健角色。急诊科应该成为社会的医疗保健安全网吗?它应该成为贫困者的主要护理提供者吗?这是否给急诊科带来了难以承受的压力?它应该提供初级医疗保健吗?如果不应该,那么替代方案是什么?