Gill J M, Diamond J J
Department of Family and Community Medicine, Medical Center of Delaware, Wilmington, USA.
Fam Med. 1996 Mar;28(3):178-82.
Medicaid recipients without a regular source of care frequently use hospital emergency departments (EDs) for minor problems. This study examined whether referring Medicaid patients to primary care physicians and obstetricians results in a decrease in ED use and an increase in physician office visits.
The statewide Voluntary Initiative Program (VIP), which referred Medicaid patients to primary care physicians and obstetricians without any managed care component, was examined. Claims data were reviewed for Medicaid clients 0-64 years old who obtained VIP referrals during the first 5 months of the program. The change in rate of visits to hospital EDs and physician offices was compared for the study group (n = 444) and for the state's overall Medicaid population (n = 40,860).
After referral, ED use decreased 24% for the VIP group and 4% for the Medicaid population. During the same period, physician office visits increased 50% for the VIP group but decreased 13% for the Medicaid population.
Even in the absence of managed care, referral to primary care physicians and obstetricians resulted in fewer ED visits and more physician office visits. These findings confirm the importance of primary care in improving the efficiency of health care delivery for the Medicaid population.
没有固定医疗服务来源的医疗补助受助者经常因小问题前往医院急诊科就诊。本研究探讨了将医疗补助患者转介给初级保健医生和产科医生是否会减少急诊科的使用并增加门诊就诊次数。
对全州范围的自愿倡议项目（VIP）进行了研究，该项目将医疗补助患者转介给初级保健医生和产科医生，且没有任何管理式医疗成分。对在该项目前5个月获得VIP转介的0至64岁医疗补助客户的理赔数据进行了审查。比较了研究组（n = 444）和该州总体医疗补助人群（n = 40,860）前往医院急诊科和门诊就诊率的变化。
转介后，VIP组的急诊科使用率下降了24%，医疗补助人群下降了4%。在同一时期，VIP组的门诊就诊次数增加了50%，而医疗补助人群减少了13%。
即使在没有管理式医疗的情况下，转介给初级保健医生和产科医生也会减少急诊科就诊次数并增加门诊就诊次数。这些发现证实了初级保健在提高医疗补助人群医疗服务效率方面的重要性。
