Robert Wood Johnson Foundation Clinical Scholars Program, the Leonard Davis Institute of Health Economics, the Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Acad Emerg Med. 2011 Oct;18(10):1036-44. doi: 10.1111/j.1553-2712.2011.01163.x.
The purpose of this study was to describe the associations between individual health insurance and ambulance utilization using a national sample of patients who receive emergency department (ED) care.
The data source was the National Hospital Ambulatory Medical Care Survey, years 2004 through 2006. Noninstitutionalized patients between ages 18 and 65 years were included. The primary dependent variable was ambulance use. Multivariable logistic regression methods were used to assess the associations between health insurance status and ambulance use and to adjust for confounders.
A total of 61,013 ED visits were included, representing a national sample of approximately 70 million annual ED visits over 3 years. Ambulance transport was used in 11% of private insurance visits, 16% of Medicaid visits, and 13% of uninsured visits. In the adjusted model, visits by patients with Medicaid (adjusted odds ratio [aOR] = 1.60, 99% confidence interval (CI) = 1.37 to 1.86) and the uninsured (aOR = 1.43, 99% CI = 1.23 to 1.66) were more likely to arrive by ambulance than visits by patients with private insurance. Ambulance use among the uninsured was most pronounced in metropolitan areas.
Ambulance use varies by health insurance status. Medicaid coverage and lack of insurance are each independently associated with increased odds of ambulance use, suggesting a disproportionate role for emergency medical services (EMS) in the care of patients with limited financial resources.
本研究旨在通过对接受急诊（ED）治疗的患者的全国样本，描述个人医疗保险与救护车使用之间的关联。
数据来源为 2004 年至 2006 年的国家医院门诊医疗调查。纳入年龄在 18 至 65 岁之间的非住院患者。主要因变量为救护车使用。多变量逻辑回归方法用于评估医疗保险状况与救护车使用之间的关联，并调整混杂因素。
共纳入 61013 例 ED 就诊，代表了 3 年内每年约 7000 万例 ED 就诊的全国样本。私人保险就诊中有 11%使用了救护车转运，医疗补助就诊中有 16%，无保险就诊中有 13%。在调整后的模型中，使用医疗补助（调整后的优势比[aOR] = 1.60，99%置信区间[CI] = 1.37 至 1.86）和无保险（aOR = 1.43，99%CI = 1.23 至 1.66）的患者就诊更有可能通过救护车到达，而不是使用私人保险的患者。在大都市地区，无保险患者的救护车使用情况最为明显。
救护车使用情况因医疗保险状况而异。医疗补助覆盖和缺乏保险都与使用救护车的几率增加独立相关，这表明紧急医疗服务（EMS）在为经济资源有限的患者提供护理方面发挥了不成比例的作用。
