Research Brief
Implications from Research Results
Presented at the February 2004 OHREC Public Meeting
SURVEY RESULTS: Individual Characteristics of Patients in the OHSU Emergency Department
The findings outlined in this brief are the result of a patient survey conducted at Oregon Health and Sciences University’s (OHSU) emergency department (ED). The self-reported reasons for visiting OHSU's ED during 2003 were analyzed to address three main research questions: Did patients attempt to obtain care in other primary care settings before visiting the ED? What were the barriers to access in other settings? What is the insurance history of uninsured patients in the OHSU ED? This survey was conducted to provide descriptive data to better understand the 17% increase in uninsured visits to the ED shown by Dr. Robert A. Lowe in his preliminary report on ED use at OHSU.1 This patient survey was conducted in the fall of 2003. Do patients attempt to obtain care in other primary care settings before visiting the ED? ♦ 45% of the study participants came to the ED on medical advice from a provider ♦ 55% came to the ED without seeking medical advice What were the reported barriers to access in other primary care settings?2 ♦ 47.2% reported they were worried about cost ♦ 43.8% didn’t have health insurance at the time ♦ 35.2% didn’t have a regular healthcare provider ♦ 33.8% couldn’t get an appointment as soon as they wanted ♦ 20.7% owed money to a doctor, clinic or hospital
OHREC is a unique collaborative of Oregon health services researchers, state agencies, stakeholders and advocates sharing and studying the impact of changes to the Oregon Health Plan. OHREC is designed to facilitate communication of research findings to policymakers, both statewide and nationally. Initial funding for the formation of the collaborative has been through Oregon's Robert Wood Johnson State Coverage Initiatives Grant through the Office of Oregon Health Policy & Research.
Changes in Access to Primary Care for Oregon Health Plan Beneficiaries and the Uninsured: A Preliminary Report 2 n=269. Multiple responses allowed. Will not sum to 100%
1
Office for Oregon Health Policy and Research
Those with shorter spans of uninsurance (6 months or less) were more likely to have come from OHP, 63.6% vs. 31.8% from Employer Sponsored Insurance (ESI) Those with uninsurance spans of greater than 1 year were more likely to have come from ESI coverage, 65% vs. 33% from OHP Top reasons cited for leaving/losing OHP: ♦ 49% reported premiums not affordable or locked out due to premiums ♦ 29% reported income too high to qualify Top reasons cited for losing ESI: ♦ 62% lost job ♦ 13% aged out of parents’ ESI or quit school
Uninsured: Most Recent Health Insurance
60% 50% 40% 30% 20% 10% 0%
d ha O th e O H pu on 't K D rc no w ES P se r I
47.9%
44.4%
0.7%
5.6%
1.4%
Key Findings Uninsured were equally likely to have come from employersponsored insurance as from the Oregon Health Plan OHP patients remained high utilizers of the ED; potentially indicating a lack of access to health care Lack of access not completely explanatory. For those not consulting a physician before the ED visit, o o Less than one-third of the respondents reported that their clinics were closed when they came to the ED Less than 25% cited lack of available or timely appointments at their usual source of care as the reason for coming to the ED
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♦ Most uninsured visiting OHSU are “short-term uninsured”: 45% uninsured less than 1 year; 27% less than 6 months; and 12% never insured ♦ OHP disenrollment (44%) and loss of employer-sponsored insurance (48%) -- largely due to job loss -- contributed equally to uninsured visits to the OHSU ED during the study period
This study was funded by the Office for Oregon Health Policy & Research through Oregon’s Robert Wood Johnson Foundation’s State Coverage Initiative grant and conducted under the direction of Tina Edlund, MS.
Office for Oregon Health Policy and Research