Advocates for Evidence-Based Health Policy Speakers
ER visits unchanged after ACA
The Affordable Care Act was supposed to expand coverage to the uninsured and many politicians claimed this would result in lower use of “expensive emergency rooms” for treatment of patients’ acute complaints. This presumption runs counter to several facts. First, that only one-fifth of patients visit the ER due to problems such as their doctor’s office being closed or lack of other providers. The vast majority goes to the ER because they (or any other prudent layperson) think they are having an actual emergency. Second, a recent randomized experiment demonstrated that giving Medicaid to the uninsured in Oregon led to a 40% increase in ER visits.
A new survey from the Center for Disease Control and Prevention (CDC), asked the question: did the ACA actually reduce ER visits as politicians promised?
Unfortunately, the study didn’t actually answer that question.
Source: CDCThe authors used the National Health Interview Survey to assess patterns of ER use among adults age 18-65 in 2013 and 2014, the years straddling the ACA’s major insurance expansions.
The data show that the percentage of people reporting a visit to an emergency department during the previous 12 months did not significantly differ between 2013 and 2014. This is true for both the Medicaid and privately insured subgroups.
The Oregon experiment clearly demonstrated that the number of during its Medicaid expansion at 18 months. A less reported aspect of the Oregon study showed that the percent of patients with any visit, which is the same measure reported by CDC, also significantly increased by about 20%. So why are these two studies not in agreement? The Oregon results differ from the CDC study in that it used an administrative database. A true comparison would require comparing the CDC data to self-reported ER visits. Fortunately, the Oregon researchers provided us that information as well. Both the Oregon and the CDC study – looking at a 12 month period – found that patients did not report any significant change in the likelihood of visiting an ER.
Source: Science. 2014 Jan 17; 343(6168): 263-268.So maybe it’s true that Obamacare hasn’t changed the overall number or likelihood of visiting the ER – contrary to our predictions – but that might just be the results of the sampling method or too short an observation period. What we really need an analysis of administrative records to truly answer this question.
commentary by Cedric Dark
Abstract
Objective—This report examines the percentage of adults aged 18–64 who had an emergency room (ER) visit and their reasons for the most recent visit.
Methods—Using the 2013 and 2014 National Health Interview Survey, estimates of use in the past year and reasons for most recent ER visit are presented. A hierarchy was created to classify respondents’ reasons for their last ER visit into three mutually exclusive categories: seriousness of the medical problem, doctor’s office or clinic was not open, and lack of access to other providers.
Results—In 2014, 18% of adults visited the ER one or more times. Seriousness
of the medical problem was the reason for the most recent ER visit for 77% of adults aged 18–64, 12% because their doctor’s office was not open, and 7% because of a lack of access to other providers (4% did not select any reason). Percentages were similar in 2013. Controlling for other variables, adults with Medicaid were most likely to report that seriousness of the medical problem was the reason for the most recent ER visit. Adults with private coverage were most likely to have used the ER because the doctor’s office was not open. Uninsured adults were more likely than adults with private coverage to have visited the ER because they lacked access to other providers. Differences in reasons for use between demographic groups were also identified.
Conclusions—Few changes in ER use were noted between 2013 and 2014. Differences persist in ER use and reasons for ER use at most recent visit by insurance type as well as sociodemographic characteristics.