Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms.
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.
Obstetrics and Gynecology Division, Soroka University Medical Center, Beer-Sheva, Israel.
Iris
I
Raz
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: novack@bgu.ac.il.
Lena
L
Novack
Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.
Maayan
M
Yitshak-Sade
Obstetrics and Gynecology Division, Soroka University Medical Center, Beer-Sheva, Israel.
Yemima
Y
Shahar
Obstetrics and Gynecology Division, The Rabin Medical Center, Petach-Tikva, Israel.
Arnon
A
Wiznitzer
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Ruslan
R
Sergienko
Sapir College, Ashqelon, Israel.
Lora
L
Warshawsky-Livne
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D017047:Cost Sharing; D036861:Delivery, Obstetric / Q000191:economics* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007557:Israel; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000191:economics; D011247:Pregnancy; D016526:Workload
HMO; Obstetrics ER; Over-crowded ER; Referral; Statutory change