Survey of health maintenance organization instructions to members concerning emergency department and 911 use.
Ann Emerg Med
; 34(1): 19-24, 1999 Jul.
Article
em En
| MEDLINE
| ID: mdl-10381990
ABSTRACT
STUDY OBJECTIVE:
Anecdotal concerns suggest that health management organization (HMO) membership instructions may deter members from calling 911 or going to an emergency department for a perceived emergency. This study examines such instructions, specifically in regard to their definition of an emergency condition and associated instructions.METHODS:
Member instructions were requested from 28 HMOs in 3 large West Coast cities with HMO penetration exceeding 30%. Fifteen (54%) provided membership materials. Features examined included the definition of an emergency, instructions for calling 911, specific instructions regarding chest pain and stroke, and mention of costs associated with emergency care.RESULTS:
Instructions and definitions varied widely. Six HMOs (40%) included chest pain in their definition of an emergency; 2 (13%) included symptoms of stroke. Ten (67%) made mention of calling 911 or going to the ED somewhere within their instructions; 4 (27%) provided no options for calling 911 or seeking ED care. Three (20%) cited higher costs associated with ED care. Eleven (73%) indicated that claims would be denied for visits determined on retrospective review to be nonemergencies.CONCLUSION:
Instructions varied considerably. Most did not include chest pain or symptoms of stroke in their definition of an emergency. Most did include directions to call 911 or go to an ED. Other instructions may lead members to call the HMO first during an emergency.
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Base de dados:
MEDLINE
Assunto principal:
Dor no Peito
/
Aceitação pelo Paciente de Cuidados de Saúde
/
Transtornos Cerebrovasculares
/
Sistemas Pré-Pagos de Saúde
/
Educação de Pacientes como Assunto
/
Serviço Hospitalar de Emergência
/
Serviços de Informação
Tipo de estudo:
Diagnostic_studies
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Ann Emerg Med
Ano de publicação:
1999
Tipo de documento:
Article
País de afiliação:
Estados Unidos