Do Mandates Requiring Insurers To Pay For Emergency Care Influence The Use Of The Emergency Department?

Hsia, Renee Y.; Chan, Jia; Baker, Laurence C.

doi:10.1377/hlthaff.25.4.1086

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…After conversing with the patient, the treating physician recorded either agreement or disagreement with this statement. The intent is not to assess the appropriateness of the emergency department presentation but rather to gain knowledge through a better understanding of the events and behaviors associated with the patient’s complaint [ 57 - 59 ]. The effort here is to judge, although imperfect, whether or not the condition could have been easily avoided.…”

Section: Methodsmentioning

confidence: 99%

Framework for classifying compliance and medical immediacy among low-acuity presentations at an urban trauma center

et al. 2015

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BackgroundThis research offers two exploratory frameworks, one for medical regimen compliance and one for medical immediacy. The first classifies compliance awareness, compliance mitigation, and financial limitation for those patients that exhibit nonadherence with a medical regimen. The second classifies medical immediacy and characterizes avoidable utilization.MethodsRepresentative sampling of adult patients presenting at an emergency department (62,000/ppy) triaged as low acuity; emergency department physician assessment of noncompliance with medical regimen for those patients with a complaint related to a chronic condition; and emergency department physician assessment of medical immediacy and avoidable utilization.ResultsPhysicians report 48.3% (95% confidence interval (CI) 43.5% to 53.1%) of patients with at least a single chronic condition are presenting with symptoms or complaint related to a chronic condition, and 39.6% (CI 31.7% to 47.4%) of these exhibit noncompliance with the medical regimen associated with that chronic condition. 16.4% (CI 6.6% to 26.1%) of the patients exhibit pseudo compliance, a belief that the medical regimen is in compliance when in fact it is not. If the patient had been in compliance, 85.9% (CI 77.0% to 94.8%) of the presenting conditions may have been mitigated. Noncompliance cases (34.5% (CI 22.0% to 47.1%)) are partly attributable to financial constraints. Further, 19.1% (CI 15.7% to 22.5%) are assessed as requiring no medical intervention and 3.4% (CI 1.8% to 4.9%) require immediate stabilization.ConclusionsA large portion of low-acuity presentations are related to a chronic condition and noncompliance with the associated medical regimen contributes to the need to seek medical services. Interventions addressing literacy and financial constraints may increase compliance and decrease utilization.

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Section: Methodsmentioning

confidence: 99%

Framework for classifying compliance and medical immediacy among low-acuity presentations at an urban trauma center

et al. 2015

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“…However, it can be difficult to compare studies about the cost of NUEDU because the term "cost" is often used to refer to what should more precisely be called charges or payments (Hsia et al, 2006). In addition to times when use of the term "cost" is technically inaccurate, there are other times when there is considerable overlap among terms.…”

Section: Nuedu: Costs Charges and Paymentsmentioning

confidence: 99%

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

DeWood¹

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DEDICATIONThis work is dedicated to my family. My husband, Gary DeWood, has provided far more encouragement and support throughout the duration of this project than either of us thought would be necessary, and has done so with grace and forbearance. My children, Patricia, Dale, and Kathryn, made many sacrifices and contributions that were material to my being able to be in school, for which I am more grateful than I can express. While it may be impossible to quantify the benefits of prayer, I am certain that the maximum of those benefits have been bestowed on me due to the fact that my mother, Alice Davis, has made countless petitions heavenward on my behalf. (Any answering of prayers that has occurred is because my mother deserves to have her prayers answered, not because I do. In any case, because of the probable reduction in requests for help, I dare say even God is relieved that my dissertation is finally complete.) The example set by my late father, Dr. Dale Davis, whose work as an adult PhD candidate I remember, exhorted me to sustain my efforts during times when it seemed that this enterprise was ill-advised for anyone who could be otherwise gainfully employed. iv ACKNOWLEDGEMENTSFirst and foremost, I thank Dr. James Vaden for being my advocate, providing encouragement, and for being a mentor without peer. I do not know by what luck it is that I was able to find such a friend.I would also like to thank all the faculty members who gave me instruction and guidance. In particular I appreciate the efforts of my committee members, Drs. Lawrence Brown, Cyril Chang, Joy Clay, Doug Imig, and Junling Wang, but most especially for those of Dr. Lawrence Brown, who had the unenviable task of assuming chairmanship of my dissertation committee late in the game. No one knows better than I do that accomplishing all that is required to obtain a Ph.D. cannot be done alone.v ABSTRACT Purpose. The purpose of this study is to examine the influence of patientperceived provider availability on nonurgent emergency department use (NUEDU). The study population consists of a nationally-representative population of non-elderly adults who were continuously privately insured (CPI) for at least a year before an emergency department visit that was determined to be nonurgent, and who reported having a regular source of care (RSC).Methods. Data were obtained from a nationally-representative longitudinal survey, the Medical Expenditure Panel Survey (MEPS). The classification of ED visits as nonurgent was based on patient report using a method developed for this study. Patient-perceived provider availability was based on patient report of how difficult it was to contact their RSC by phone for medical advice during office hours (Regular Hours Contact), how difficult it was to reach their RSC after hours in case of an urgent problem (After Hours Contact), and whether their RSC had office hours at night or on weekends (Night or Weekend Hours). Multiple logistic regression analysis was used to determine whether the patient-reported provider ava...

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“…It may be due to frustration with previous attempts that the US Congress cast a wide enough net in EMTALA such that some courts interpret the law as permitting any individual who enters the emergency room to invoke EMTALA protection should the hospital refuse to screen and stabilize the patient's condition. Yet, the issue of whether EMTALA was only meant for the economically disadvantaged (Hsia et al, 2006;Hurley et al, 2005) still burns in legal analyses. The question was addressed by IJPHM 1,3 the US Court of Appeals for the Fourth Circuit.…”

Section: Emtalamentioning

confidence: 99%

The marketing concept, patient dumping and EMTALA

Bonnici

2007

International Journal of Pharmaceutical and Healthcare Marketing

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Purpose -The purpose of this paper is to show that in the presence of the marketing concept something is fundamentally wrong in our national health care system where patients are denied emergency medical treatment or are prematurely transferred from one hospital to another because they cannot guarantee payment. Design/methodology/approach -A viewpoint is discussed citing supporting literature. Findings -The literature suggests an adverse relationship between the marketing concept and the Emergency Medical Treatment and Active Labor Act (EMTALA) and further suggests that the two are failing indigent patients. The marketing concept as a driving business philosophy is too simplistic and commercially oriented to befit an emergency setting. At the same time, EMTALA suffers from serious shortcomings, shackles hospitals' freedom of contract and threatens the economics of health care.Research limitations/implications -The paper lacks quantitative research to back its position. Practical implications -It is not enough to coin positively sounding theories within healthcare marketing when these theories are inadequate in addressing the stark realities behind supply and demand. EMTALA as a remedial measure falls short in correcting the situation and a fresh outlook at the problem is warranted. Originality/value -The paper taps into marketing and legal expertise in bringing together the marketing concept and EMTALA, two subjects that have never been twinned before in the literature. The subjects are of special interest in understanding the treatment of indigent patients.

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Do Mandates Requiring Insurers To Pay For Emergency Care Influence The Use Of The Emergency Department?

Cited by 4 publications

References 9 publications

Framework for classifying compliance and medical immediacy among low-acuity presentations at an urban trauma center

Framework for classifying compliance and medical immediacy among low-acuity presentations at an urban trauma center

The Influence of Patient-Reported Provider Availability Factors on Nonurgent Emergency Department Use

The marketing concept, patient dumping and EMTALA

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