Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms

Iris Raz, Lena Novack, Maayan Yitshak-Sade, Yemima Shahar, Arnon Wiznitzer, Ruslan Sergienko, Lora Warshawsky-Livne

Research output: Contribution to journalArticlepeer-review

Abstract

In view of the growing proportion of "non-urgent" admissions to obstetric emergency rooms (OERs) and recent changes in copayment policies for OER visits in Israel, we assessed factors contributing to OER overcrowding. The changes investigated were (a) exemption from copayment for women with birth contractions, (b) allowing phone referrals to the OER and (c) exemption from copayment during primary care clinic closing hours.We analyzed data of a large tertiary hospital with 37 deliveries per day. Counts of women discharged to home from the OER were an indicator of "non-urgent" visits.The annual number of non-urgent visits increased at a higher rate (3.4%) than the natural increase in deliveries (2.1%). Exemption from copayment for visits during non-working hours of primary care clinics was associated with increases in OER admissions (IRR. = 1.22) and in non-urgent OER visits (IRR. = 1.54). Younger and first-time mothers with medically unjustified complaints were more likely to be discharged to home.We showed that the changes in the policy for OER copayment meant to attract new clients to the HMO had an independent impact on OER utilization, and hence, added to the workload of medical personnel. The change in HMO policy regulating OER availability requires rigorous assessment of possible health system implications.

Original languageEnglish
Pages (from-to)1358-1365
Number of pages8
JournalHealth Policy
Volume119
Issue number10
DOIs
StatePublished - Oct 2015
Externally publishedYes

Keywords

  • HMO
  • Obstetrics ER
  • Over-crowded ER
  • Referral
  • Statutory change

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