Mackinney Ted, Visotcky Alexis M, Tarima Sergey, Whittle Jeff
Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
J Prim Care Community Health. 2013 Apr 1;4(2):135-42. doi: 10.1177/2150131913478981. Epub 2013 Mar 11.
Access to primary care could reduce use of more costly health care by uninsured individuals through prevention and early treatment. We analyzed data from a program providing free primary care to test this hypothesis.
We compared emergency room (ER) visits and hospitalizations among uninsured, low-income adults who received immediate versus delayed access to a program providing free primary care, including labs, X-rays, and specialty consultation. We used surveys to identify ER visits and hospitalizations during the 12 months preceding and following program enrollment or wait list entry.
Hospitalizations decreased from the year before entry to the year following entry in participants with immediate and delayed (6.0% vs 8.8% decrease) access. ER use also decreased in both groups (11.2% vs 15.4%).
Free primary care services and specialty consultation did not reduce use of more costly health care services during its first year. More prolonged availability of primary care might have greater impact.
通过预防和早期治疗，获得初级保健服务可以减少未参保个体对成本更高的医疗保健服务的使用。我们分析了一个提供免费初级保健服务项目的数据，以验证这一假设。
我们比较了未参保的低收入成年人中，立即获得与延迟获得包括实验室检查、X光检查和专科会诊在内的免费初级保健服务项目的人群的急诊室就诊和住院情况。我们通过调查来确定在项目登记或进入等候名单之前及之后12个月内的急诊室就诊和住院情况。
立即获得和延迟获得服务的参与者，从进入项目前一年到进入项目后一年，住院率均有所下降（分别下降6.0%和8.8%）。两组的急诊室就诊率也都有所下降（分别下降11.2%和15.4%）。
免费初级保健服务和专科会诊在第一年并没有减少对成本更高的医疗保健服务的使用。初级保健服务的更长时间提供可能会产生更大影响。
