Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms
| Autor: | Maayan Yitshak-Sade, Iris Raz, Lena Novack, Arnon Wiznitzer, Lora Warshawsky-Livne, Yemima Shahar, Ruslan Sergienko |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Referral Obstetric emergency Primary care Workload Nursing Pregnancy Health care Medicine Humans Maternal Health Services Cost Sharing Israel Copayment Academic Medical Centers business.industry Health Policy Overcrowding medicine.disease Delivery Obstetric Primary care clinic Obstetric Labor Complications Female Medical emergency business Emergency Service Hospital |
| Zdroj: | Health policy (Amsterdam, Netherlands). 119(10) |
| ISSN: | 1872-6054 |
| Popis: | In view of the growing proportion of "non-urgent" admissions to obstetric emergency rooms (OERs) and recent changes in copayment policies for OER visits in Israel, we assessed factors contributing to OER overcrowding. The changes investigated were (a) exemption from copayment for women with birth contractions, (b) allowing phone referrals to the OER and (c) exemption from copayment during primary care clinic closing hours. We analyzed data of a large tertiary hospital with 37 deliveries per day. Counts of women discharged to home from the OER were an indicator of "non-urgent" visits. The annual number of non-urgent visits increased at a higher rate (3.4%) than the natural increase in deliveries (2.1%). Exemption from copayment for visits during non-working hours of primary care clinics was associated with increases in OER admissions (IRR=1.22) and in non-urgent OER visits (IRR=1.54). Younger and first-time mothers with medically unjustified complaints were more likely to be discharged to home. We showed that the changes in the policy for OER copayment meant to attract new clients to the HMO had an independent impact on OER utilization, and hence, added to the workload of medical personnel. The change in HMO policy regulating OER availability requires rigorous assessment of possible health system implications. |
| Databáze: | OpenAIRE |
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