Division of General Internal Medicine, Department of Medicine, University of California, Irvine, Irvine, California.
Department of Medicine, University of California, Irvine, Irvine, California.
Health Serv Res. 2019 Aug;54(4):827-838. doi: 10.1111/1475-6773.13154. Epub 2019 Apr 29.
To identify consumers' preferences over care settings, such as physicians' offices, emergency rooms (ERs), urgent care centers, retail clinics, and virtual physicians on smartphones, for minor illnesses.
A survey conducted between 9/27/16 and 12/7/16 emailed to all University of California, Irvine employees.
Participants were presented with 10 clinical scenarios and asked to choose the setting in which they wanted to receive care. We estimated multinomial conditional logit regression models, conditioning the choice on out-of-pocket costs, wait time, travel time, and chooser characteristics.
5451 out of 21 037 employees responded.
Out-of-pocket costs and wait time had minimal impact on patient's preference for site of care. Choices were driven primarily by the clinical scenario and patient characteristics. For chronic conditions and children's well-visits, the doctor's office was the preferred choice by a strong majority, but for most acute conditions, either the ER (for high severity) or urgent care clinics (for lower severity) were preferred to the office setting, particularly among younger patients and those with less education.
Patients have several alternatives to traditional physicians' offices and ERs. The low impact of out-of-pocket costs suggests that insurers interested in encouraging increased utilization of alternatives would need to consider substantial changes to benefit structure.
确定患者对医疗服务场所的偏好，例如医生办公室、急诊室（ER）、紧急护理中心、零售诊所和智能手机上的虚拟医生，用于治疗小病。
2016 年 9 月 27 日至 12 月 7 日向加利福尼亚大学欧文分校的所有员工发送的调查电子邮件。
向参与者展示了 10 种临床情况，并要求他们选择想要接受治疗的场所。我们估计了多项条件逻辑回归模型，根据自付费用、等待时间、旅行时间和选择者特征对选择进行了条件限制。
21037 名员工中有 5451 人做出了回应。
自付费用和等待时间对患者选择医疗服务场所的偏好影响很小。选择主要取决于临床情况和患者特征。对于慢性疾病和儿童常规健康检查，医生办公室是大多数患者的首选，但对于大多数急性疾病，ER（严重程度高）或紧急护理诊所（严重程度低）比办公室更受欢迎，特别是在年轻患者和受教育程度较低的患者中。
患者有几种替代传统医生办公室和 ER 的选择。自付费用的影响较低表明，有兴趣鼓励增加替代选择的保险公司可能需要考虑对福利结构进行重大改变。
