The emergency use of CMU beneficiaries are often preventable

This is among the beneficiaries of universal health coverage (CMU) that the use of avoidable emergency is the most common, confirms French analysis also highlights the existence of a threshold effect in the consumption of health care

Emergencies ... for consultation

Given the increase in attendance of emergency hospital services observed for more than 10 years, Alain Parponaris and colleagues from Inserm unit U379 sought to define the consumption patterns of care of persons admitted to the emergency room and connect social and economic conditions declared by them.

They investigated the accident and emergency service (UAS) of the Saint-Roch Hospital in Nice to identify the nature and grounds of appeal of persons admitted, the medical consumption during the last 12 months and all socio-economic characteristics.

Interns and evaluated the type of appeal with the scale five classes of common classification of emergency patients (CCEP). Class 1 corresponds to patients who do not justify "making diagnostic or therapeutic supplemental indenture to the emergency" and whose support could be provided elsewhere than emergencies, the authors note in the journal "The Medical Press. "

In contrast, classes 4 and 5 include patients whose prognosis is considered committed.

Among the 463 patients whose answers could be exploited, nearly half (47.3%) fell within the accidental pathology or trauma, four in ten of somatic and non-traumatic causes about 13% of psychological, psychiatric or related to drug dependence.

The distribution of causes of action is, however, not identical to the classes of the scale of the CCEP, the authors state: in fact, non-traumatic causes somatic constitute the bulk of use in classes 3-5 for which prognosis is worse. At the same time, the proportion of psychological or psychiatric causes in the use of level 1 is significantly higher than in all other classes of the scale.

In general, do not have a regular doctor, aged less than 30 years and have seen a psychiatrist during the year are three elements associated with an increase in the likelihood of avoidable emergency use.

Those benefiting from the CMU consumption care substantially similar to those with higher incomes do not allow them to benefit from this welfare. In contrast, individuals whose income is below a certain amount (288 euros in the study), also supposed to benefit from the CMU, seem not access care because of their "social and cultural marginalization" which According to the authors, has "contributed to a health avulsion [...] revealing real problems of access to care."

A threshold effect in the consumption of health care

The study also highlights a threshold effect in the consumption of health care, "potentially not induce corrective measures put in place." This threshold effect affects those "whose income is still insufficient to ensure proper financial access to care, but over the limit to qualify for this benefit," the authors say.

People whose income is above the limit can benefit from the complementary CMU and consume less care than the average population, but less than some of the beneficiaries of the CMU. And it is in this class that appeals to preventable emergencies are the most frequent.

"The UAA is a substitute without immediate advance payment can pass it in the eyes of these users to a free service," comment the authors recommend to consider more carefully the effects of expanders insurance coverage disease to previously excluded "to ensure a continuum of care of the health needs of low-income populations."