Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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The Impact of an Emergency Fee Increase on the Composition of Patients Visiting Emergency Departments

  • Jung, Hyemin (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Do, Young Kyung (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Kim, Yoon (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Ro, Junsoo (Department of Health Policy and Management, Seoul National University College of Medicine)
  • Received : 2014.09.24
  • Accepted : 2014.10.27
  • Published : 2014.11.30
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Abstract

Objectives: This study aimed to test our hypothesis that a raise in the emergency fee implemented on March 1, 2013 has increased the proportion of patients with emergent symptoms by discouraging non-urgent emergency department visits. Methods: We conducted an analysis of 728 736 patients registered in the National Emergency Department Information System who visited level 1 and level 2 emergency medical institutes in the two-month time period from February 1, 2013, one month before the raise in the emergency fee, to March 31, 2013, one month after the raise. A difference-in-difference method was used to estimate the net effects of a raise in the emergency fee on the probability that an emergency visit is for urgent conditions. Results: The percentage of emergency department visits in urgent or equivalent patients increased by 2.4% points, from 74.2% before to 76.6% after the policy implementation. In a group of patients transferred using public transport or ambulance, who were assumed to be least conscious of cost, the change in the proportion of urgent patients was not statistically significant. On the other hand, the probability that a group of patients directly presenting to the emergency department by private transport, assumed to be most conscious of cost, showed a 2.4% point increase in urgent conditions (p<0.001). This trend appeared to be consistent across the level 1 and level 2 emergency medical institutes. Conclusions: A raise in the emergency fee implemented on March 1, 2013 increased the proportion of urgent patients in the total emergency visits by reducing emergency department visits by non-urgent patients.

Keywords

References

  1. Oh YH. Issues on the emergency medical service system in Korea. Health Welf Issue Focus 2011;(105):1-8 (Korean).
  2. Cho CH, Lee EJ. A study on improvement of large-size hospital's emergency medical service according to patient's viewpoint. J Korean Soc Qual Manag 2013;41(4):541-553 (Korean). https://doi.org/10.7469/JKSQM.2013.41.4.541
  3. Park HR, Moon JS, Youn SJ. Satisfaction regarding the usage of emergency treatment service. J Korea Community Health Nurs Acad Soc 2000;14(2):293-303 (Korean).
  4. Lee HK, Do BS, Lee SB. Appropriateness of the use of emergency medical services and propensities toward choice by local residents of hospitals. J Korean Soc Emerg Med 2010;21(5):525-530 (Korean).
  5. Ahn KO, Yun SY, Lee SJ, Jung KY, Cho JH, Jo HS. Definition and analysis of overcrowding in the emergency department of ten tertiary hospitals. J Korean Soc Emerg Med 2004;15(4):261-272 (Korean).
  6. Arnold JL, Song HS, Chung JM. The recent development of emergency medicine in South Korea. Ann Emerg Med 1998;32(6):730-735. https://doi.org/10.1016/S0196-0644(98)70074-5
  7. Jung KY, Lim KS, Min YI, Lee SB, Kim SK. Current status of emergency medical service and emergency patient. J Korean Soc Emerg Med 1997;8(3):441-460 (Korean).
  8. Seo DW, Lim KS, Moon YS, Shon YD, Jo MW, Kim W, et al. Effect of the new emergency fee schedule on the pattern of emergency patients. J Korean Soc Emerg Med 2004;15(4):227-232 (Korean).
  9. Selby JV, Fireman BH, Swain BE. Effect of a copayment on use of the emergency department in a health maintenance organization. N Engl J Med 1996;334(10):635-641. https://doi.org/10.1056/NEJM199603073341006
  10. Hsu J, Price M, Brand R, Ray GT, Fireman B, Newhouse JP, et al. Cost-sharing for emergency care and unfavorable clinical events: findings from the safety and financial ramifications of ED copayments study. Health Serv Res 2006;41(5):1801-1820. https://doi.org/10.1111/j.1475-6773.2006.00562.x
  11. Becker DJ, Blackburn J, Morrisey MA, Sen B, Kilgore ML, Caldwell C, et al. Co-payments and the use of emergency department services in the children's health insurance program. Med Care Res Rev 2013;70(5):514-530. https://doi.org/10.1177/1077558713491501
  12. Wai AK, Chor CM, Lee AT, Sittambunka Y, Graham CA, Rainer TH. Analysis of trends in emergency department attendances, hospital admissions and medical staffing in a Hong Kong university hospital: 5-year study. Int J Emerg Med 2009;2(3):141-148. https://doi.org/10.1007/s12245-009-0098-7
  13. Benitez MA. Hong Kong tackles health-service overload by charging emergency fee. Lancet 2002;360(9347):1757.
  14. Lowe RA, Fu R, Gallia CA. Impact of policy changes on emergency department use by Medicaid enrollees in Oregon. Med Care 2010;48(7):619-627. https://doi.org/10.1097/MLR.0b013e3181dbddb1
  15. Newhouse JP, Ellis RP. Free for all? Lessons from the RAND health insurance experiment. J Econ Literature 1995;33(3):1364.
  16. Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med 2008;52(2):126-136. https://doi.org/10.1016/j.annemergmed.2008.03.014
  17. Richardson DB, Mountain D. Myths versus facts in emergency department overcrowding and hospital access block. Med J Aust 2009;190(7):369-374.
  18. Park IC, Lee KR, Goo HD, Kim SW, Jang SJ, Sim HS. Emergency transfer for resolving emergency department overcrowding. J Korean Soc Emerg Med 1995;6(2):403-410.
  19. Yoo IS. What to do to improve emergency care. Health Welf Policy Forum 2010;(169):45-57 (Korean).
  20. Richardson LD, Asplin BR, Lowe RA. Emergency department crowding as a health policy issue: past development, future directions. Ann Emerg Med 2002;40(4):388-393. https://doi.org/10.1067/mem.2002.128012
  21. Jung JH, Bae HA. The effectiveness of operating fast track by board certified emergency physician in emergency medical center of teaching hospital. J Korean Soc Emerg Med 2008;19(4):372-377 (Korean).
  22. Chung SH, Yoon HD, Na BJ. Characteristics of non-emergent patients at emergency departments. Korean J Health Policy Adm 2006;16(4):128-146 (Korean). https://doi.org/10.4332/KJHPA.2006.16.4.128

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