Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome - 05/09/11
For the Rapid Early Action for Coronary Treatment (REACT) Study
Abstract |
Study Objective: Cost concerns may inhibit emergency medical services (EMS) use. Novel tax-based and subscription prepayment programs indemnify patients against the cost of EMS treatment and transport. We determine whether the presence of (or enrollment in) prepayment plans increase EMS use among patients with acute chest discomfort, particularly those residing in low-income areas, those lacking private insurance, or both. Methods: This study uses a subset of baseline data from the REACT trial, a multicenter, randomized controlled community trial designed, in part, to increase EMS use. The sample includes 860 consecutive noninstitutionalized patients (>30 years old) presenting with nontraumatic chest discomfort to hospital emergency departments in 4 Oregon/Washington communities. The association between prepayment systems and EMS use was analyzed using multivariable logistic regression. Results: Overall EMS use was 52% (n=445). Among EMS users, 338 (75%) were subsequently admitted to the hospital and 110 (25%) were released from the ED. Prepayment was not associated with increased EMS use in the overall patient sample. However, patients residing in low-income census block groups (median annual income <$30,000) were 2.6 times (95% confidence interval [CI] 1.4 to 4.8) more likely to use EMS when a prepayment system was available than when no system was present. No association was noted among higher-income block group residents. Among low-income block group residents lacking private insurance, prepayment systems were associated with 3.8 times (95% CI 1.2 to 13.4) greater EMS usage. Conclusion: Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event. Prepayment systems may increase EMS utilization among these groups. [Seipmann DB, Mann NC, Hedges JR, Daya MR, for the Rapid Early Action for Coronary Treatment (REACT) Study. Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. Ann Emerg Med. June 2000;35:573-578.]
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 | Supported by grant No. HL53141-03 from the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, and an American Heart Association Summer Student Award to Mr. Siepmann. The authors are solely responsible for the content of the article, and the opinions do not necessarily represent the views of any listed funding source. |
| Mr. Siepmann was a medical student at Oregon Health Sciences University (OHSU) during the time this research was conducted. The majority of Dr. Mann’s efforts on this project occurred during his activity on the faculty at OHSU, Department of Emergency Medicine. |
 | Address for reprints: N. Clay Mann, PhD, MS, Intermountain Injury Control Research Center, University of Utah School of Medicine, Department of Pediatrics, 410 Chipeta Way, Suite 222, Salt Lake City, UT 84108-9161; 801-585-9161; fax 801-581-8686; E-mail: clay.mann@hsc.utah.edu . |
Vol 35 - N° 6
P. 573-578 - juin 2000 Retour au numéro
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