The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Objectives: This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. Methods: We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. Results: The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% beforeto 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumedto be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. Conclusions: A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.
Abstract
Objectives: This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. Methods: We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. Results: The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% beforeto 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumedto be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. Conclusions: A raise in the emergency fee implemented on March 1, 2013 increased the propoEmergency fee, Hospital emergency service, Overcrowding, Difference-in-differencertion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.
참고문헌 (22)
- Oh YH, "Issues on the emergency medical service system in Korea", Health Welf Issue Focus, (105), pp.1~8 (2011)
- 조철호, "환자관점에 따른 대형병원의 응급의료서비스 개선연구", 품질경영학회지, 41(4), pp.541~554 (2013), 한국품질경영학회[DOI]
- Park HR, "Satisfaction regarding the usage of emergency treatment service", J Korea Community Health Nurs Acad Soc, 14(2), pp.293~303 (2000)
- 이한국, "구급차 동승을 통한 지역주민의 응급의료체계 이용의 적절성 및 성향 조사", 대한응급의학회지, 21(5), pp.525~530 (2010), 대한응급의학회
- 안기옥, "응급센터 과밀화 현상의 정의와 특징분석 - 전국 1 0개 병원 대상으로", 대한응급의학회지, 15(4), pp.261~272 (2004), 대한응급의학회
- Arnold JL, "The recent development of emergency medicine in South Korea", Ann Emerg Med, 32(6), pp.730~735 (1998)
- Jung KY, "Current status of emergency medical service and emergency patient", J Korean Soc Emerg Med, 8(3), pp.441~460 (1997)
- 서동우, "응급의료관리료 제도 시행 전후의 응급환자 내원 양상의 변화와 효과", 대한응급의학회지, 15(4), pp.227~232 (2004), 대한응급의학회
- Selby JV, "Effect of a copayment on use of the emergency department in a health maintenance organization", N Engl J Med, 334(10), pp.635~641 (1996)
- Hsu J, "Cost-sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study", Health Serv Res, 41(5), pp.1801~1820 (2006)
- Becker DJ, "Co-payments and the use of emergency department services in the children’s health insurance program", Med Care Res Rev, 70(5), pp.514~530 (2013)
- Wai AK, "Analysis of trends in emergency department attendances, hospital admissions and medical staffing in a Hong Kong university hospital: 5-year study", Int J Emerg Med, 2(3), pp.141~148 (2009)
- Benitez MA, "Hong Kong tackles health-service overload by charging emergency fee", Lancet, 360(9347), pp.1757~ (2002), 360(9347
- Lowe RA, "Impact of policy changes on emergency department use by Medicaid enrollees in Oregon", Med Care, 48(7), pp.619~627 (2010)
- Newhouse JP, "Free for all? Lessons from the RAND health insurance experiment", J Econ Literature, 33(3), pp.1364~ (1995)
- Hoot NR, "Systematic review of emergency department crowding: causes, effects, and solutions", Ann Emerg Med, 52(2), pp.126~136 (2008)
- Richardson DB, "Myths versus facts in emergency department overcrowding and hospital access block", Med J Aust, 190(7), pp.369~374 (2009)
- Park IC, "Emergency transfer for resolving emergency department overcrowding", J Korean Soc Emerg Med, 6(2), pp.403~410 (1995)
- Yoo IS, "What to do to improve emergency care", Health Welf Policy Forum, (169), pp.45~57 (2010)
- Richardson LD, "Emergency department crowding as a health policy issue: past development, future directions", Ann Emerg Med, 40(4), pp.388~393 (2002)
- 정진희, "일개 응급의료센터에서 전문의에 의한 fast track 운영의 효과", 대한응급의학회지, 19(4), pp.372~377 (2008), 대한응급의학회
- 정설희, "응급실을 이용하는 비응급환자의 실태와 특성", 보건행정학회지, 16(4), pp.128~146 (2006), 한국보건행정학회