Department of Emergency Medicine, Oregon Health Sciences University, Portland, OR.
Intermountain Injury Control Research Center, University of Utah School of Medicine, Salt Lake City, UT.
Ann Emerg Med. 2000 Jun;35(6):573-578. doi: 10.1016/S0196-0644(00)70030-8. Epub 2005 Nov 4.
Cost concerns may inhibit emergency medical services (EMS) use. Novel tax-based and subscription prepayment programs indemnify patients against the cost of EMS treatment and transport. We determine whether the presence of (or enrollment in) prepayment plans increase EMS use among patients with acute chest discomfort, particularly those residing in low-income areas, those lacking private insurance, or both.
This study uses a subset of baseline data from the REACT trial, a multicenter, randomized controlled community trial designed, in part, to increase EMS use. The sample includes 860 consecutive noninstitutionalized patients (>30 years old) presenting with nontraumatic chest discomfort to hospital emergency departments in 4 Oregon/Washington communities. The association between prepayment systems and EMS use was analyzed using multivariable logistic regression.
Overall EMS use was 52% (n=445). Among EMS users, 338 (75%) were subsequently admitted to the hospital and 110 (25%) were released from the ED. Prepayment was not associated with increased EMS use in the overall patient sample. However, patients residing in low-income census block groups (median annual income <$30,000) were 2.6 times (95% confidence interval [CI] 1.4 to 4.8) more likely to use EMS when a prepayment system was available than when no system was present. No association was noted among higher-income block group residents. Among low-income block group residents lacking private insurance, prepayment systems were associated with 3.8 times (95% CI 1.2 to 13.4) greater EMS usage.
Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event. Prepayment systems may increase EMS utilization among these groups. [Seipmann DB, Mann NC, Hedges JR, Daya MR, for the Rapid Early Action for Coronary Treatment (REACT) Study. Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. Ann Emerg Med. June 2000;35:573-578.].
费用问题可能会影响急救医疗服务（EMS）的使用。新型基于税收和订阅预付款的计划可确保患者无需承担 EMS 治疗和转运费用。我们旨在确定预付款计划的存在（或参与）是否会增加急性胸痛患者（尤其是居住在低收入地区、缺乏私人保险或两者兼有的患者）使用 EMS 的频率。
本研究使用了 REACT 试验的基线数据子集，该试验是一项多中心、随机对照的社区试验，旨在增加 EMS 的使用。该样本包括来自俄勒冈州和华盛顿州的 4 个社区医院急诊部门的 860 名连续非住院患者（>30 岁），这些患者因非创伤性胸痛就诊。使用多变量逻辑回归分析预付款系统与 EMS 使用之间的关系。
总体 EMS 使用比例为 52%（n=445）。在使用 EMS 的患者中，338 名（75%）随后被收入医院，110 名（25%）从 ED 出院。预付款与患者总体样本中 EMS 使用频率的增加无关。然而，居住在低收入人口普查块组（中位年收入<$30,000）的患者在有预付款系统时使用 EMS 的可能性是没有系统时的 2.6 倍（95%置信区间 [CI] 1.4 至 4.8）。在收入较高的块组居民中没有发现关联。在缺乏私人保险的低收入块组居民中，预付款系统与 EMS 使用频率增加 3.8 倍（95% CI 1.2 至 13.4）相关。
经济因素可能会影响保险不足和低收入心脏病患者对 EMS 系统的使用。预付款系统可能会增加这些人群对 EMS 的使用。
