University of Massachusetts Medical School, Worcester.
RTI International, Waltham, MA.
Med Care. 2019 Feb;57(2):101-108. doi: 10.1097/MLR.0000000000001025.
Conceptually, access to primary care (through insurance) should reduce emergency department (ED) visits for primary care sensitive (PCS) conditions. We sought to identify characteristics of insured Massachusetts residents associated with PCS ED use, and compare such use for public versus private insurees.
People under age 65 in the Massachusetts All-Payer Claims Data, 2011-2012.
Retrospective, observational analysis of PCS ED use with nonurgent, urgent/primary care treatable, and urgent/potentially avoidable visits being considered PCS. We predicted utilization in 2012 using multivariable regression models and data available in 2011 administrative records.
Among 2,269,475 nonelderly Massachusetts residents, 40% had public insurance. Among public insurees, PCS ED use was higher than for private (mean, 36.5 vs. 9.0 per 100 persons; adjusted risk ratio, 2.53; 95% confidence limits, 2.49-2.56), while having any primary care visit was less common (70% vs. 83%), as was having any visit to one's own (attributed) primary care provider (38% vs. 44%).
Public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.
从概念上讲，获得初级保健（通过保险）应该会减少因初级保健敏感（PCS）病症而前往急诊部（ED）就诊的次数。我们试图确定与 PCS ED 使用相关的参保马萨诸塞州居民的特征，并比较公共保险和私人保险的使用情况。
2011-2012 年马萨诸塞州所有支付者索赔数据中年龄在 65 岁以下的人群。
使用多变量回归模型对 PCS ED 使用情况进行回顾性观察性分析，将非紧急、紧急/初级保健可治疗和紧急/潜在可避免的就诊视为 PCS。我们使用 2011 年行政记录中可用的 2012 年数据预测利用情况。
在 2269475 名非老年马萨诸塞州居民中，40%有公共保险。在公共保险参保者中，PCS ED 使用高于私人保险（平均值，36.5 比 9.0/100 人；调整风险比，2.53；95%置信区间，2.49-2.56），而进行任何初级保健就诊的情况较少（70%比 83%），进行任何自己（归因）的初级保健提供者就诊的情况也较少（38%比 44%）。
公共保险与较少的初级保健机会和较多的 PCS ED 使用相关；全州范围内的劳动力短缺和公共保险的低报销率可能导致获得医疗服务的机会不足，这可能有助于减少 PCS ED 的使用。
