Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
N Engl J Med. 1994 May 19;330(20):1426-30. doi: 10.1056/NEJM199405193302007.
Visits to the emergency department by Medicaid recipients for nonemergency problems are common and contribute to rising health care costs. However, such patients may have few alternatives. We conducted a telephone survey of 953 ambulatory care sites in 10 cities to determine the availability of appointments for Medicaid recipients with common problems.
Research assistants telephoned all ambulatory care clinics and a stratified sample of private primary care practices in the catchment area served by the hospital emergency department in each city. The assistants identified themselves as Medicaid recipients seeking care for one of three problems (low back pain, dysuria, or sore throat) and asked a standardized series of questions. Data were collected on appointments or walk-in visits authorized at any time, within two days after the call, or after 5 p.m.; copayment requirements; and reasons appointments could not be made. If an appointment was made, it was canceled at the end of each call or shortly thereafter. Several weeks later, private-practice sites in six of the cities were recontacted; the research assistants identified themselves as patients with private insurance and the same problem.
An appointment or an authorization for a walk-in visit was obtained from 418 of the 953 practice sites (44 percent); 47 of the sites (5 percent) could not be contacted. Appointment rates for the different types of sites ranged from 72 percent for free-standing urgent care centers to 34 percent for private practices. "Not accepting Medicaid" was the most common reason given for not granting an appointment or walk-in visit. Only 72 of the sites (8 percent) offered after-hours care within two working days after the call without a cash copayment. Sixty percent of the 330 private practices that were recontacted agreed to see a patient with private insurance within two working days, but only 26 percent agreed to see a patient with Medicaid within two days (P < 0.001).
Medicaid recipients in urban areas have limited access to outpatient care apart from that offered by hospital emergency departments.
医疗补助受助人因非紧急问题前往急诊科就诊的情况很常见，这导致了医疗保健成本的上升。然而，这类患者可能没有太多其他选择。我们对10个城市的953个门诊医疗场所进行了电话调查，以确定患有常见疾病的医疗补助受助人能否预约就诊。
研究助理给每个城市医院急诊科服务区域内的所有门诊医疗诊所和分层抽样的私人初级保健机构打电话。助理表明自己是寻求治疗三种疾病（腰痛、排尿困难或喉咙痛）之一的医疗补助受助人，并询问一系列标准化问题。收集有关随时、通话后两天内或下午5点后授权的预约或即看即诊的数据；共付费用要求；以及无法预约的原因。如果预约成功，在每次通话结束时或之后不久取消预约。几周后，再次联系其中六个城市的私人执业场所；研究助理表明自己是患有相同疾病的私人保险患者。
在953个执业场所中，418个（44%）获得了预约或即看即诊的授权；47个场所（5%）无法联系到。不同类型场所的预约率从独立的紧急护理中心的72%到私人执业机构的34%不等。“不接受医疗补助”是不给予预约或即看即诊最常见的原因。只有72个场所（8%）在通话后两个工作日内提供无需现金共付的非工作时间护理。在再次联系的330个私人执业机构中，60%同意在两个工作日内接待有私人保险的患者，但只有26%同意在两天内接待有医疗补助的患者（P<0.001）。
城市地区的医疗补助受助人除了医院急诊科提供的门诊护理外，获得门诊护理的机会有限。
