Sox C M, Burstin H R, Edwards R A, O'Neil A C, Brennan T A
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
Am J Med. 1998 Dec;105(6):506-12. doi: 10.1016/s0002-9343(98)00324-6.
To assess the effect of insurance status on the probability of admission and subsequent health status of patients presenting to emergency departments.
We performed a prospective cohort study of patients with common medical problems at five urban, academic hospital emergency departments in Boston and Cambridge, Massachusetts. The outcome measure for the study was admission to the hospital from the emergency department and functional health status at baseline and follow-up.
During a 1-month period, 2,562 patients younger than 65 years of age presented with either abdominal pain (52%), chest pain (19%) or shortness of breath (29%). Of the 1,368 patients eligible for questionnaire, 1,162 (85%) completed baseline questionnaires, and of these, 964 (83%) completed telephone follow-up interviews 10 days later. Fifteen percent of patients were uninsured and 34% were admitted to the hospital from the emergency department. Uninsured patients were significantly less likely than insured patients to be admitted, both when adjusting for urgency, chief complaint, age, gender and hospital (odds ratio = 0.5, 95% confidence interval 0.3 to 0.7), and when additionally adjusting for comorbid conditions, lack of a regular physician, income, employment status, education and race (odds ratio = 0.4, 95% confidence interval 0.2 to 0.8). However, there were no differences in adjusted functional health status between admitted and nonadmitted patients by insurance status, either at baseline or at 10-day follow-up.
Uninsured patients with one of three common chief complaints appear to be less frequently admitted to the hospital than are insured patients, although health status does not appear to be affected. Whether these results reflect underutilization among uninsured patients or overutilization among insured patients remains to be determined.
评估保险状况对前往急诊科就诊患者的入院概率及后续健康状况的影响。
我们对马萨诸塞州波士顿和剑桥市五家城市学术医院急诊科中患有常见医疗问题的患者进行了一项前瞻性队列研究。该研究的结局指标为从急诊科入院情况以及基线和随访时的功能健康状况。
在为期1个月的时间里，2562名65岁以下患者因腹痛（52%）、胸痛（19%）或呼吸急促（29%）前来就诊。在1368名符合问卷调查条件的患者中，1162名（85%）完成了基线问卷调查，其中964名（83%）在10天后完成了电话随访访谈。15%的患者未参保，34%的患者从急诊科入院。在调整了紧急程度、主要症状、年龄、性别和医院因素后（比值比=0.5，95%置信区间0.3至0.7），以及在进一步调整了合并症、无固定医生、收入、就业状况、教育程度和种族因素后（比值比=0.4，95%置信区间0.2至0.8），未参保患者入院的可能性均显著低于参保患者。然而，无论在基线时还是在10天随访时，按保险状况分类，入院患者与未入院患者在调整后的功能健康状况方面均无差异。
患有三种常见主要症状之一的未参保患者入院频率似乎低于参保患者，尽管健康状况似乎未受影响。这些结果是反映了未参保患者利用不足还是参保患者利用过度，仍有待确定。
