ABSTRACT
BACKGROUND: Approximately 19% of non-elderly adults are without health insurance. The uninsured frequently lack a source of primary care and are more likely to use the emergency department (ED) for routine care. Improving access to primary care for the uninsured is one strategy to reduce ED overutilization and related costs. METHODS: A comparison group quasi-experimental design was used to evaluate a broad-based community partnership that provided access to care for the uninsured-Project Access Dallas (PAD)-on ED utilization and related costs. Eligible uninsured patients seen in the ED were enrolled in PAD (n = 265) with similar patients not enrolled in PAD (n = 309) serving as controls. Study patients were aged 18-65 years, <200% of the federal poverty level and uninsured. Outcome measures include the number of ED visits, hospital days and direct and indirect costs. RESULTS: PAD program enrollees had significantly fewer ED visits (0.93 vs. 1.44; P < 0.01) and fewer inpatient hospital days (0.37 vs. 1.07; P < 0.05) than controls. Direct hospital costs were â¼60% less ($1188 vs. $446; P < 0.01) and indirect costs were 50% less ($313 vs. $692; P < 0.01). CONCLUSIONS: A broad-based community partnership program can significantly reduce ED utilization and related costs among the uninsured.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Health Care Coalitions/organization & administration , Health Services Accessibility/organization & administration , Medically Uninsured/statistics & numerical data , Adolescent , Adult , Age Distribution , Cost Savings/methods , Emergency Service, Hospital/economics , Emergency Service, Hospital/trends , Female , Health Care Coalitions/economics , Health Services Accessibility/economics , Health Services Accessibility/standards , Humans , Male , Middle Aged , Models, Organizational , Outcome Assessment, Health Care , Poverty , Sex Distribution , Texas , Young AdultSubject(s)
Managed Care Programs/statistics & numerical data , Medicaid/organization & administration , Mental Disorders/epidemiology , Patient Care Team/statistics & numerical data , Contract Services , Humans , Iowa , Mental Disorders/therapy , Primary Health Care/statistics & numerical data , United States , Utilization ReviewABSTRACT
In the future, demand management will be required of health care organizations that become at-risk for the cost of care. Methods for identifying market segments composed of high users need to be adopted and routinely employed. The study reported here is an example of such an effort. Physician visits in a farming-dependent county in the upper-middle west were assessed via postal questionnaire in this study. A 15-percent random sample of households yielded 327 surveys. The frail elderly, low-income elderly, low-income adults, and recently hospitalized middle-aged and elderly persons were identified as market segments disproportionately composed of high users. Demand management programs might fruitfully be targeted at these groups. Judicious clinic expansions might reduce medical office visits.
