Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
PLoS One. 2018 May 10;13(5):e0197282. doi: 10.1371/journal.pone.0197282. eCollection 2018.
In June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits.
We conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits where an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011-2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Bivariate or multivariate logistic regression analysis was performed to yield odds ratios (OR) with 95% confidence intervals.
There were a total of 612 IFH claims made in the ED from 2011-2013. The demographic characteristics, acuity of presentation and discharge diagnoses were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, adjusted OR 4.28, 95% CI: 2.18-8.40; p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, unadjusted OR 1.67, 95% CI: 1.14-2.44; p<0.05) yet a higher proportion of patients without a family physician were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, unadjusted OR 2.85, 95% CI: 1.45-5.62; p<0.05).
A higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012, as demonstrated in the logistic regression analysis in this health records review, represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate primary care for this population, yet this was not reflected in the follow-up advice offered by ED physicians to patients.
2012 年 6 月，联邦政府削减了临时联邦卫生（IFH）计划，这减少或取消了加拿大难民申请人的健康保险。本研究的目的是研究这些变化对使用 IFH 福利的患者在急诊部（ED）的使用的影响。
我们在渥太华的两家三级护理 ED 进行了病历回顾。我们在 2012 年 6 月 30 日（2011-2013 年）计划变更前后的 18 个月内，对在分诊时提出 IFH 索赔的所有 ED 就诊进行了审查。在削减之前和之后进行了索赔比较，比较了基本人口统计学特征，主要表现投诉，严重程度，诊断，初级保健的存在以及索赔的财务状况。进行了双变量或多变量逻辑回归分析，得出 95%置信区间的优势比（OR）。
2011-2013 年，ED 共提出了 612 项 IFH 索赔。在前后两个时期，人口统计学特征，表现严重程度和出院诊断均相似。总体而言，削减后根据 IFH 计划提出的索赔减少了 28.6%。在削减之后，提出的索赔中有更多的被拒绝（削减后为 13.7%，削减前为 3.9%，调整后的 OR 4.28，95%CI：2.18-8.40；p<0.05）。大多数（75.0%）被拒绝的索赔未被患者支付。削减后，更多的患者表示他们有家庭医生（削减后为 20.4%，削减前为 30%，未调整的 OR 1.67，95%CI：1.14-2.44；p<0.05），但未接受家庭医生治疗的患者中有更高的比例仍被建议在后期随访期间与家庭医生联系（削减后为 67.2%，削减前为 41.8%，未调整的 OR 2.85，95%CI：1.45-5.62；p<0.05）。
从这项健康记录审查中的逻辑回归分析可以看出，2012 年 6 月 IFH 削减后，无论是被拒绝的索赔还是随后未支付的索赔比例都更高，这可能成为紧急医疗护理的潜在障碍，也可能给患者和医院带来新的经济负担。ED 中 IFH 索赔的减少以及有机会获得家庭医生的患者人数的减少表明，该人群的初级保健不足，但 ED 医生向患者提供的后续建议并未反映这一点。
