Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA.
Med Care. 2010 Jul;48(7):619-27. doi: 10.1097/MLR.0b013e3181dbddb1.
In 2003, Oregon's Medicaid expansion program, the Oregon Health Plan (OHP), implemented premiums and copayments and eliminated outpatient behavioral health services. We ascertained whether these changes, including $50 copayments for emergency department (ED) visits, affected ED use.
This study used statewide administrative data on 414,009 adult OHP enrollees to compare ED utilization rates (adjusted for patient characteristics) in 3 time periods: (1) before the cutbacks, (2) after the cutbacks, and (3) after partial restoration of benefits. We examined overall ED visits and several subsets of ED visits: visits requiring hospital admission, injury-related, drug-related, alcohol-related, and other psychiatric visits. Because the policy changes affected only the expansion program (OHP Standard), we ascertained the impact of these changes compared with a control group of categorically eligible Medicaid enrollees (OHP Plus).
Compared with the control group, case-mix-adjusted ED utilization rates fell 18% among OHP Standard enrollees after the cutbacks. The rate of ED visits leading to hospitalization fell 24%. Injury-related visits and psychiatric visits excluding chemical dependency exhibited a similar pattern to overall ED visits. Drug-related ED visits increased 32% in the control group, perhaps reflecting the closure of drug treatment programs after the cutbacks reduced their revenue.
The policy changes were followed by a substantial reduction in ED use. That ED visits requiring hospital admission fell to about the same extent as overall ED use suggests that OHP enrollees may have been discouraged from using EDs for emergencies as well as less-serious problems.
2003 年，俄勒冈州的医疗补助扩展计划——俄勒冈健康计划（OHP）实施了保费和共同支付，并取消了门诊行为健康服务。我们确定了这些变化，包括急诊部（ED）就诊的 50 美元共同支付，是否会影响 ED 的使用。
本研究使用了全州范围内的行政数据，涉及 414,009 名 OHP 成年参保者，比较了 3 个时期的 ED 利用率（根据患者特征进行调整）：（1）削减之前，（2）削减之后，以及（3）部分恢复福利之后。我们检查了总体 ED 就诊次数以及几个 ED 就诊的子集：需要住院的就诊、伤害相关的就诊、药物相关的就诊、酒精相关的就诊和其他精神科就诊。由于政策变化仅影响扩展计划（OHP Standard），我们确定了与分类合格的医疗补助参保者（OHP Plus）对照组相比，这些变化的影响。
与对照组相比，削减后 OHP Standard 参保者的病例组合调整后的 ED 利用率下降了 18%。导致住院的 ED 就诊率下降了 24%。伤害相关就诊和排除药物依赖的精神科就诊呈现出与总体 ED 就诊类似的模式。药物相关的 ED 就诊在对照组中增加了 32%，这可能反映了削减后药物治疗计划的关闭减少了它们的收入。
政策变化之后，ED 使用量大幅减少。需要住院的 ED 就诊率下降到与总体 ED 就诊率大致相同的程度，这表明 OHP 参保者可能被劝阻不要将 ED 用于急诊和不太严重的问题。
