While uninsured patients are often thought of as high emergency department (ED) utilizers, insured patients, particularly those with Medicaid coverage, have come to rely more frequently on EDs, according to a study from the University of California, San Francisco.
In order to investigate recent trends between insurance coverage and ED use, researchers analyzed California ED visits by adults aged 19 to 64 years old from 2005 to 2010. ED visits were grouped into four categories based on expected source of payment: Medicaid, private insurance, self-pay or uninsured, and other. Researchers also looked at ED visits for ambulatory care sensitive conditions (ACSCs).
Key findings from the study include the following:
- Between 2005 and 2010, the number of visits to California EDs by adults overall increased by 13.2 percent from 5.4 to 6.1 million per year.
- Among Medicaid beneficiaries, the rate increased from 572 to 651 visits per 1000.
- Among the privately insured, the rate rose from 158 to 164 visits per 1000.
- Among the uninsured, the rate rose from 242 to 259 visits per 1000.
- Medicaid patients consistently had the highest rate of visits for potentially preventable conditions.
- The largest increase in ED visits occurred in 2009, likely due to the H1N1 pandemic and the influence of the economic downturn on coverage transitions and access to care.
Emergency rooms (ERs) are deeply affected by insurance patterns over time, and with the upcoming rollout of the ACA, which will expand eligibility for Medicaid among many other significant changes, ERs likely will be impacted even more, according to the researchers. These findings could reflect a nationwide trend under the ACA, they add. Many uninsured people are expected to transition to Medicaid, and as a result, overall ED use may increase because Medicaid patients have higher rates of ED use. At the same time, some states are proposing cuts to Medicaid or refusing to expand it, which could exacerbate waiting time in the ER.
Source: University of California San Francisco (UCSF) , September 17, 2013
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