Hospital Admission Through the Emergency Department-Reply

Abstract

In Reply. —We agree with Dr Pane that delays in seeking care and low socioeconomic status are among the several reasons patients admitted through the ED use more health care resources. Because of these patterns of resource use, it is important to consider modification of the existing hospital payment system. We concur that entry of emergency physicians into the current health policy dialogue is a positive development. The informal study by Tachakra et al demonstrates differences in length of stay nearly identical to those we noted. We were unable to account fully for these differences using established measures of severity and socioeconomic status. We agree with Tachakra et al that prospective collection of data on patients' social supports, socioeconomic status, and severity of illness would be useful in efforts to assess patients' resource needs and determine equitable payment to hospitals under per case or global budgeting systems of health care