Frequent Use of the ER Fell After the Affordable Care Act
The odds of being a frequent user of
In a health-records study of nearly 14 million patients who visited a
Overall, 6.6 million patients visited a
This increase, however, does not account for the fact that many more people were covered by Medicaid over this time period. When the researchers controlled for the increase in Medicaid coverage and other insurance changes, they found that Medicaid and uninsured patients had 0.88 and 0.69 times the odds of being a frequent ED user, respectively, after the ACA implementation (2014-2015), compared to the pre-ACA period (2012-2013). Privately insured patients experienced little change in the frequency of their visits.
The finding suggests that the nation's largest expansion of health insurance in more than 50 years may have led to improved access to health care services, reducing the need to use emergency departments as a primary source of care, particularly among people served by public insurance programs.
"Our findings do not necessarily suggest that the ACA caused a decrease in frequent emergency department use among Medicaid and uninsured patients, but rather provides evidence that expanded Medicaid coverage might have allowed these patients to access services for serious health conditions outside of the ED," said senior author
"Efforts to address frequent ED use should take into account Medicaid managed care plans and coordinated mechanisms that provide physical and behavioral health resources across networks," Hsia said.
Frequent use of the emergency department often serves as a marker for poor access to non-emergency medical care. Uninsured frequent ED use also is a significant driver in health care costs.
Before the ACA, nearly 27 percent of
The study is published in Health Affairs.
Most studies of frequent ED use were conducted before 2014, when several major provisions of the ACA were implemented. Under the legislation, some 20 million adults gained health insurance coverage, primarily through expansion of Medicaid eligibility, as well as new insurance marketplaces and subsidies.
In 2017, there were 29.3 million people nationally without health insurance, down from 48.6 million in 2010, according to the
The new study controlled for factors such as health status, primary insurance coverage sources and counties of residence. In addition to insurance coverage, other patient characteristics - including race or ethnicity and health condition - were significantly associated with frequent ED use during the study period, the researchers found. Diagnoses of a mental health condition or substance use disorder were the largest predictors of frequent ED use, with mentally ill patients having at least twice the odds. Non-Hispanic blacks also had 1.27 times the odds than non-Hispanic whites to be a frequent ED user.
The first author of the study is
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