Medicaid patients aren’t overusing ER, study says

Posted July 12, 2012, at 10:48 p.m.

WASHINGTON — Policymakers frequently say that Medicaid patients overuse the emergency room for routine care, citing it as a factor driving up health care costs.

But a new study says that the majority of Medicaid visits to the emergency room are for urgent or serious issues.

“There’s this perception that Medicaid patients go to the emergency department for very little things that could easily be addressed elsewhere,” said study author Emily Carrier. “What we found here is that Medicaid patients use the emergency department for the same reason as the privately insured.”

When Medicaid patients went to the emergency room, they did so for largely acute medical problems, according to the research published Wednesday by the Center for Studying Health System Change. Three-quarters of the Medicaid visits were categorized as emergent, urgent or semi-urgent. Among those with private coverage, the number stood at 78 percent.

The study found that Medicaid patients do have a significantly higher rate of emergency department use. In 2008, Medicaid enrollees had 45.8 emergency room visits per 100 enrollees, compared with 24 visits for the same number of privately insured individuals.

“This research turns the conventional wisdom on its head,” said Karoline Mortensen, a University of Maryland professor whose research focuses on patterns of care among low-income Americans. “It’s critical for policy solutions that we have a better understanding of the problem. The blunt instrument of saying we won’t pay for those visits isn’t going to be effective in a situation like this.”

Mortensen’s own research has looked at how implementing a co-payment in Medicaid changes emergency department use. She published a 2010 study finding that such policies had no effect on patterns of care — and thinks this new paper helps explain why.

“There’s a misconception that people decide they can’t get to their primary-care doctor, so they will hang out in the emergency room all day,” Mortensen said. “This is saying, that’s not really the case.”

The study relied on data from the National Hospital Ambulatory Medical Care Survey, a federal database that tracks trips to emergency departments across the country. Researchers combed through the 34,134 records of emergency department visits in 2008, the most recent year for which data is available.

This study adds to a growing body of research aiming to understand how Medicaid patients use health care, developing at the same time that governors weigh whether to participate in the health law’s Medicaid expansion.

Researchers have used Oregon’s 2008 Medicaid expansion — where some low-income residents gained coverage via a lottery, from a pool of 89,000 applicants — to understand how the program affects people’s lives.

The study found that those who gained Medicaid coverage reported being in better mental and physical health and were less likely to have unpaid medical bills.

What did not change, however, were patterns of emergency department use. Both those who gained Medicaid — and those without insurance — used the emergency department at the same level.

“We have no evidence that Medicaid reduces emergency department use,” said Harvard University’s Katherine Baicker, a co-author of the study.

Baicker and her colleagues have, so far, only analyzed self-reported data on emergency department use. In forthcoming research, they will look at hospitals’ administrative data to understand what type of medical conditions individuals sought treatment for in the emergency room.

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