Abstract
In 1983 a budget shortfall at the Seattle Veterans Administration Medical Center prompted termination of regular outpatient care for individuals of low legal priority deemed medically stable by administrative criteria. The authors examined the effects on health status and access to medical care of 157 discharged patients and 74 comparison subjects who met the discharge criteria but were retained. Seventeen months after termination, 41% of discharged patients reported their self-perceived health status was “much worse,” compared with 8% of retained patients (p < 0.001). Among discharged patients, 23% had seen no health care provider, 58% believed they lacked access to necessary care, and 47% had reduced prescribed medications. In contrast, all retained patients had seen a provider, 5% claimed to lack access, and 25% had reduced medications. Among discharged patients for whom complete follow-up data were available, the percentage whose blood pressures were out of control at their 13-month follow-up visits was 41%, compared with 5% at the time of discharge. This marked change contrasted with a rise from 9% to 17% among retained patients. A best-case/worse-case analysis indicated that the findings could not be fully explained by biased follow-up. Administrative criteria did not accurately identify medically stable patients. During the study interval 25% of discharged patients were hospitalized and at least 6% died. These findings suggest that federal health care programs are important to many indigent patients and that withdrawing services may have deleterious consequences
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Received from the Department of Medicine, University of Washington, and Medical Service, Seattle Veterans Administration Medical Center, Seattle, Washington.
Supported in part by the Medical Student Research Training Program of the University of Washington and by the Northwest Health Services Research and Development Field Program of the Veterans Administration.
All opinions expressed are the authors’ and not necessarily those of the Veterans Administration or the University of Washington.
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Fihn, S.D., Wicher, J.B. Withdrawing routine outpatient medical services. J Gen Intern Med 3, 356–362 (1988). https://doi.org/10.1007/BF02595794
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DOI: https://doi.org/10.1007/BF02595794