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Health Care Costs and Financing

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Insurance status influences patients' access to urgent followup appointments after emergency department care

Most patients who visit an emergency department (ED) are treated and discharged with a recommendation to follow up with a primary care physician. To avoid hospitalization or an adverse outcome, patients need timely access to followup care after the ED visit. Insurance status influences whether a patient can get a timely followup appointment, according to a study supported in part by the Agency for Healthcare Research and Quality (HS13007).

Researchers found that 98 percent of clinics contacted by individuals needing followup care after an ED visit screened callers to determine their insurance status, yet only 28 percent of clinics attempted to determine the severity of the caller's condition. Appointment rates for callers insured by Medicaid were only marginally better than those for uninsured callers who offered to pay $20.

Brent R. Asplin, M.D., M.P.H., of HealthPartners Research Foundation, and colleagues had research assistants call 430 randomly selected outpatient clinics in 9 cities in 2002 and 2003. The research assistants identified themselves as new patients who had been seen in an ED and needed an urgent followup appointment within a week for one of three clinical vignettes (pneumonia, hypertension, or possible tubal pregnancy).

Nearly half (47 percent) of total callers and 64 percent of privately insured callers were offered appointments within a week. Callers who claimed to have private insurance were more likely to receive appointments than those who claimed to have Medicaid coverage (64 vs. 34 percent). Callers reporting private insurance coverage had higher appointment rates than callers who reported that they were uninsured but offered to pay $20 and arrange payment of the balance (65 vs. 25 percent), but the same appointment rates as uninsured callers who were willing to pay cash for the entire visit fee (66 vs. 63 percent). One-third of the clinics contacted could not provide access to a new patient within a week, even one with private insurance.

More details are available in "Insurance status and access to urgent ambulatory care follow-up appointments," by Dr. Asplin, Karin V. Rhodes, M.D., Helen Levy, Ph.D., and others, in the September 22, 2005, Journal of the American Medical Association 294, pp. 1248-1254.

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