TY - JOUR
T1 - Insurance coverage and health care consumers' use of emergency departments
T2 - Has managed care made a difference?
AU - Smith Speck, Sandra K.
AU - Peyrot, Mark
AU - Hsiao, Chiao Wen
N1 - Funding Information:
Sandra K. Smith Speck is affiliated with Loyola College, Baltimore, MD. Mark Peyrot is Director of Sociology, Director, Center of Social & Community Research Loyola College, 4501 North Charles Street, Baltimore MD 21210. Chiao-Wen Hsiao is affiliated with the Center for Social & Community Research Loyola College, 4501 North Charles Street, Baltimore MD 21210. Address correspondence to: Sandra K. Smith Speck, Loyola College, 4501 North Charles Street, Baltimore, MD 21210-2699 (E-mail: sspeck@loyola.edu). The authors acknowledge a grant from the Sellinger School of Business and Management of Loyola College.
PY - 2003
Y1 - 2003
N2 - How successful has managed care been in controlling costs and consumers' inappropriate use of health care services? This study compares national data from 1992 and 1996 to determine the effect of managed care on appropriateness of ED utilization. ED utilization was described in two ways as defined in Gooding, Smith, and Peyrot (1996): (1) urgency of visit (urgent vs. non-urgent), and (2) appropriateness of visit taking into account the care provided upon visits (including treatment and diagnostic procedures) and disposition of visit (admit, transfer, and discharge against medical advice). Potentially appropriate visits were the non-urgent cases at which treatment procedures and/or non-routine diagnostic procedures were performed. All urgent visits were defined as appropriate. Study results reveal that consumers' ED misuse changed in complex ways over the period examined. Contrary to our assumptions based on earlier research, the pattern of change was not the same for the two different measures of misuse. Non-urgent use decreased, as hypothesized, but there was an increase in non-urgent use which we have defined as inappropriate (i.e., no treatment and no non-routine diagnostic tests). ED misuse did not decrease more for insured than uninsured consumers, nor more for managed care than fee-for-service consumers. These findings bring into question the efficacy of efforts to address rising health care costs through controlling consumer utilization of services via managed care, efforts mirrored by many fee-for-service indemnity plans. Future research is needed to determine why this consumer misuse of the ED appears to continue and how the recent increase in the marketing of ED services may exacerbate this problem.
AB - How successful has managed care been in controlling costs and consumers' inappropriate use of health care services? This study compares national data from 1992 and 1996 to determine the effect of managed care on appropriateness of ED utilization. ED utilization was described in two ways as defined in Gooding, Smith, and Peyrot (1996): (1) urgency of visit (urgent vs. non-urgent), and (2) appropriateness of visit taking into account the care provided upon visits (including treatment and diagnostic procedures) and disposition of visit (admit, transfer, and discharge against medical advice). Potentially appropriate visits were the non-urgent cases at which treatment procedures and/or non-routine diagnostic procedures were performed. All urgent visits were defined as appropriate. Study results reveal that consumers' ED misuse changed in complex ways over the period examined. Contrary to our assumptions based on earlier research, the pattern of change was not the same for the two different measures of misuse. Non-urgent use decreased, as hypothesized, but there was an increase in non-urgent use which we have defined as inappropriate (i.e., no treatment and no non-routine diagnostic tests). ED misuse did not decrease more for insured than uninsured consumers, nor more for managed care than fee-for-service consumers. These findings bring into question the efficacy of efforts to address rising health care costs through controlling consumer utilization of services via managed care, efforts mirrored by many fee-for-service indemnity plans. Future research is needed to determine why this consumer misuse of the ED appears to continue and how the recent increase in the marketing of ED services may exacerbate this problem.
KW - Consumers
KW - Emergency departments
KW - Health care costs
KW - Insurance
KW - Managed care
UR - http://www.scopus.com/inward/record.url?scp=11844257655&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=11844257655&partnerID=8YFLogxK
U2 - 10.1300/J375v15n01_02
DO - 10.1300/J375v15n01_02
M3 - Article
C2 - 15683015
AN - SCOPUS:11844257655
SN - 1539-0942
VL - 15
SP - 3
EP - 18
JO - Journal of Hospital Marketing and Public Relations
JF - Journal of Hospital Marketing and Public Relations
IS - 1
ER -