Out-of-Network Emergency Department Use among Managed Medicaid Beneficiaries
| Autor: | Maria C. Raven, David Sanchez-Migallon Guzman, John Kornak, Margot Kushel, Alice Hm Chen |
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| Rok vydání: | 2017 |
| Předmět: |
Health plan
Male health plan out-of-network Cross-sectional study Ambulances Policy and Administration Ethnic group Emergency Care 0302 clinical medicine Residence Characteristics 80 and over 030212 general & internal medicine Aged 80 and over Emergency Service Continental Population Groups 030503 health policy & services Health Policy Utilization of Health Care Services Census Middle Aged Health Services Public Health and Health Services Health Policy & Services Female Medical emergency Emergency Service Hospital 0305 other medical science Adult Adolescent Odds 03 medical and health sciences Hospital Young Adult Clinical Research medicine Ambulance Diversion Humans ambulance Aged Primary Health Care business.industry Medicaid Racial Groups Emergency department medicine.disease ED United States Cross-Sectional Studies Socioeconomic Factors San Francisco business |
| Zdroj: | Health services research, vol 52, iss 6 |
| Popis: | Author(s): Raven, Maria C; Guzman, David; Chen, Alice H; Kornak, John; Kushel, Margot | Abstract: ObjectiveOut-of-network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors associated with out-of-network ED use among Medicaid beneficiaries.Data sources and study settingEnrollment, claims, and encounter data for adult Medi-Cal health plan members with 1+ ED visits and complete Medicaid eligibility during the study period from 2013 to 2014.Study designWe analyzed the data to identify factors associated with out-of-network ED use classified by mode of arrival (ambulance vs. nonambulance).Data extraction methodsWe extracted encounter, ambulance, and ED census data and linked them together based on ED visit date.Principal findingsOf 11,143 ED visits, 6,808 (61.1 percent) were out-of-network. The number of hours the study ED was on ambulance diversion increased the odds of out-of-network visits for the 3,365 (30.2 percent) ED visits arriving by ambulance. For all visit types, assignment to a primary care clinic at the in-network hospital and having had any primary care visit during the study period decreased the odds of out-of-network ED care. Individuals were more likely to go out-of-network for ED care if they lived in neighborhoods containing out-of-network EDs.ConclusionsThere are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care. EDs that serve Medicaid beneficiaries may need to explore alternative sites and modalities of care as alternatives to the ED, and consider their ability to absorb large numbers of out-of-network visits given already limited capacity. |
| Databáze: | OpenAIRE |
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