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Use of the emergency department by refugees under the Interim Federal Health Program: A health records review

INTRODUCTION: In June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claimi...

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Autores principales: Bakewell, Francis, Addleman, Sarah, Dickinson, Garth, Thiruganasambandamoorthy, Venkatesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945039/
https://www.ncbi.nlm.nih.gov/pubmed/29746538
http://dx.doi.org/10.1371/journal.pone.0197282
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author Bakewell, Francis
Addleman, Sarah
Dickinson, Garth
Thiruganasambandamoorthy, Venkatesh
author_facet Bakewell, Francis
Addleman, Sarah
Dickinson, Garth
Thiruganasambandamoorthy, Venkatesh
author_sort Bakewell, Francis
collection PubMed
description INTRODUCTION: In June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits. METHODS: We conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits where an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011–2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Bivariate or multivariate logistic regression analysis was performed to yield odds ratios (OR) with 95% confidence intervals. RESULTS: There were a total of 612 IFH claims made in the ED from 2011–2013. The demographic characteristics, acuity of presentation and discharge diagnoses were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, adjusted OR 4.28, 95% CI: 2.18–8.40; p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, unadjusted OR 1.67, 95% CI: 1.14–2.44; p<0.05) yet a higher proportion of patients without a family physician were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, unadjusted OR 2.85, 95% CI: 1.45–5.62; p<0.05). CONCLUSION: A higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012, as demonstrated in the logistic regression analysis in this health records review, represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate primary care for this population, yet this was not reflected in the follow-up advice offered by ED physicians to patients.
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spelling pubmed-59450392018-05-25 Use of the emergency department by refugees under the Interim Federal Health Program: A health records review Bakewell, Francis Addleman, Sarah Dickinson, Garth Thiruganasambandamoorthy, Venkatesh PLoS One Research Article INTRODUCTION: In June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits. METHODS: We conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits where an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011–2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Bivariate or multivariate logistic regression analysis was performed to yield odds ratios (OR) with 95% confidence intervals. RESULTS: There were a total of 612 IFH claims made in the ED from 2011–2013. The demographic characteristics, acuity of presentation and discharge diagnoses were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, adjusted OR 4.28, 95% CI: 2.18–8.40; p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, unadjusted OR 1.67, 95% CI: 1.14–2.44; p<0.05) yet a higher proportion of patients without a family physician were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, unadjusted OR 2.85, 95% CI: 1.45–5.62; p<0.05). CONCLUSION: A higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012, as demonstrated in the logistic regression analysis in this health records review, represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate primary care for this population, yet this was not reflected in the follow-up advice offered by ED physicians to patients. Public Library of Science 2018-05-10 /pmc/articles/PMC5945039/ /pubmed/29746538 http://dx.doi.org/10.1371/journal.pone.0197282 Text en © 2018 Bakewell et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Bakewell, Francis
Addleman, Sarah
Dickinson, Garth
Thiruganasambandamoorthy, Venkatesh
Use of the emergency department by refugees under the Interim Federal Health Program: A health records review
title Use of the emergency department by refugees under the Interim Federal Health Program: A health records review
title_full Use of the emergency department by refugees under the Interim Federal Health Program: A health records review
title_fullStr Use of the emergency department by refugees under the Interim Federal Health Program: A health records review
title_full_unstemmed Use of the emergency department by refugees under the Interim Federal Health Program: A health records review
title_short Use of the emergency department by refugees under the Interim Federal Health Program: A health records review
title_sort use of the emergency department by refugees under the interim federal health program: a health records review
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5945039/
https://www.ncbi.nlm.nih.gov/pubmed/29746538
http://dx.doi.org/10.1371/journal.pone.0197282
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