Calculating the cost of emergency care.

摘要: Americans will visit hospital emergency departments (EDs) more than 110 million times this year. Federal statistics document a steadily increasing rate of ED use, especially among persons older 44 years. The cost providing care to many people is substantialdboth in human and economic terms. But it excessive? In issue Annals, 3 Rand economists present an analysis the marginal relationship volume. This same trio who recently described California’s market as ‘‘robust’’ declared that crowding California not problem. new study, authors had 2 goals. first determine if higher volumes use are associated with ‘‘economies scale.’’ second was calculate outpatient visit. Two different approaches were used derive these estimates: descriptive publicly available accounting data complex, ‘‘statistical’’ approach models estimated from 9-year panel data. Neither much detail. Before conducting either analysis, excluded visits resulted immediate hospitalization. explanation, their own words, that, ‘‘For most part, patients end up being admitted through do constitute misuse resources.’’ Readers can decide for themselves whether statement reflects degree bias on part authors. Once subset excluded, large heterogeneous array ‘‘outpatient’’ remained. At one disease spectrum ill injured complex challenging problems. Patients like frequently require careful evaluation, diagnostic tests, lengthy periods treatment before they be safely discharged home. other least urgent visitsdthe sort insurance executives want us steer primary settings rather treat ED. Because no way subdivide database by triage severity or complexity, don’t know how fell at spectrum, somewhere between. Averaging across highly diverse group produced ‘‘low side,’’ accounting-based estimate US$126 US$192 per ‘‘nontrauma’’ ‘‘trauma’’ ED, respectively, ‘‘high