对自费前往急诊部就诊的患者在前往急诊部之前先咨询其全科医生给予经济激励的效果。

Murphy A W, Leonard C, Plunkett P K, Bury G, Lynam F, Smith M, Gibney D

Department of General Practice, Royal College of Surgeons in Ireland, Mercer's Health Centre, Dublin, Ireland.

Fam Pract. 1997 Oct;14(5):407-10. doi: 10.1093/fampra/14.5.407.

BACKGROUND

The Health (Out-Patient Charges) Regulations 1994 were designed to encourage those Irish patients liable for their own health care costs to attend their GP before their local Accident and Emergency (A&E) department. Such patients are referred to as General Medical Services (GMS)-ineligible. Prior to the introduction of the regulations in March 1994, there was a perverse financial incentive for these patients to attend directly A&E departments instead of their GP.

OBJECTIVE

The aim was to compare the number of GMS-ineligible patients referred by a GP during the year before and the year after the implementation of the Regulations.

METHOD

This study involved the audit of all new attendances to a large A&E department, for 1 year before and after the introduction of the new regulations. The main outcome measures were the number of new attenders in the subsequent year, the proportion of GMS-ineligible attenders, the proportion of GMS-ineligible attenders referred by a GP and the proportion of GMS-ineligible attenders referred by a GP and categorized as having neither critical nor urgent complaints.

RESULTS

The total number of new attenders in the year subsequent to the introduction of the regulations was 45,302, an increase of 4.9% on the previous year's total. The proportion of GMS-ineligible attenders decreased from 45.3 to 44% (-1.3%; 95% confidence interval (CI) -0.6 to -1.9). The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.4% (95%; CI 1.7-3.1). The proportion of GMS-ineligible attenders, referred by a GP with complaints categorized as neither critical nor urgent, increased by 2.5% (95%; CI 1.8-3.2).

CONCLUSIONS

The introduction of the regulations was associated with a small, but statistically significant, reduction in the number of GMS-ineligible patients who attended with non-emergency conditions. The proportion of GMS-ineligible attenders who were referred by a GP increased by 2.4% (95%; CI 1.7-3.1). The overall workload of the A&E department was, however, unaffected. Further evaluation of the effects of this reduction on the health status of patients is required.

背景

1994年《健康（门诊收费）条例》旨在鼓励那些需自行承担医疗费用的爱尔兰患者在前往当地急诊部门之前先去看全科医生。这类患者被称为不符合普通医疗服务（GMS）资格者。在1994年3月该条例实施之前，这些患者直接前往急诊部门而非全科医生处就诊存在一种反常的经济诱因。

目的

目的是比较条例实施前一年和实施后一年全科医生转诊的不符合GMS资格患者的数量。

方法

本研究对一家大型急诊部门在新条例实施前后各1年的所有新就诊患者进行了审核。主要观察指标包括次年的新就诊患者数量、不符合GMS资格就诊者的比例、由全科医生转诊的不符合GMS资格就诊者的比例，以及由全科医生转诊且被归类为既无危急也无紧急病症的不符合GMS资格就诊者的比例。

结果

条例实施后的次年新就诊患者总数为45302人，比上一年总数增加了4.9%。不符合GMS资格就诊者的比例从45.3%降至44%（-1.3%；95%置信区间（CI）-0.6至-1.9）。由全科医生转诊的不符合GMS资格就诊者的比例增加了2.4%（95%；CI 1.7 - 3.1）。由全科医生转诊且病症被归类为既无危急也无紧急的不符合GMS资格就诊者的比例增加了2.5%（95%；CI 1.8 - 3.2）。