Medicaid Increases Emergency Room Visits
The Affordable Care Act is making Medicaid available to more people throughout the country with hopes of reducing stress on the emergency department. In theory, the expansion should eliminate the need to use hospital emergency rooms for anything but emergent cases. According to the Centers for Disease Control and Prevention (CDC), ER visits have been rising exponentially since 1996, while the actual number of departments has decreased. A recent study published in Science magazine indicts the plan may have backfired.
Uninsured and the ER
The general perception in the medical industry is uninsured patients who use the emergency department for basic health care are creating a strain on the system. These individuals do not have access to a primary care physician, so when they need treatment of any kind, they go to the hospital.
The National Center for Health Statistics released a report in 2010 that dispels this myth. The NCHS data shows Medicaid enrollees are three times more likely to go to the ER than uninsured individuals. This information corresponds with a recent study of the Oregon Medicaid expansion program.
Medicaid Expansion in Oregon
In 2008, Oregon began a limited expansion of their Medicaid program to cover low-income adults. At the time, they selected candidates based on a lottery system. This randomized approach gave researchers an opportunity to see the effects of the expanded coverage. They correlated emergency department data from Portland-area hospitals and came to some surprising conclusions.
The Oregon Study
The escalation of ER traffic has long been blamed on uninsured patients who use these departments for primary care. The Oregon study suggests that the actual culprit might be Medicaid enrollees.
Emergency room visits account for 11 percent of all ambulatory care cases throughout the country. The Oregon report shows 32 percent of individuals enrolled in Medicaid used the ER at least once in 12-month period. Only 17 percent of patients with private insurance went to the hospital and one in five persons with no insurance visited the ED. The numbers also prove that Medicaid patients are more likely to seek treatment at the hospital twice in one year than those individuals without any insurance.
Policymakers claim that expanding Medicaid reduces cost and improves the efficiency of hospital emergency rooms. The senior author of the study, MIT economics professor Amy Finkelstein, says the exact opposite is true. Providing government funded insurance for more people raises emergency department traffic on a large scale. The study reviewed data from 12 hospitals, each one showing a surge in ER visits, mostly outpatient cases with no corresponding admission. Finkelstein states the increase was more pronounced in cases that were non-emergent and treatable by a primary care physician. They were unable to prove that Medicaid expansion caused a decrease in ER visits in multiple scenarios.
This is not the only study of this type done. A 2006 report on the Massachusetts expansion found there was no change in emergency department visits as a result of their increased Medicaid enrollments. Economist Raymond Fisman with the Columbia Business Schools says the Oregon study provides conclusive proof, however, that insuring low-income individuals will increase ER traffic.
Part of the problem is with the primary care physicians themselves. Many will refer patients to the ER when they have a full schedule or see the case as time-consuming, according to Fisman. Policymakers thought expanding insurance opportunities would be a positive step towards managing the bloated healthcare system in the United States, but the Oregon study is proving that might not be the case.