Thu March 20, 2014
Does Having Health Insurance Boost ER Visits?
Another study seems to suggest that, contrary to previous assumptions, it does.
Researchers from Beth Israel Deaconess Medical Center in Boston have just published the results of a study in the Annals of Emergency Medicine that looked at all emergency department visits at 69 hospitals between the fall of 2006 and the fall of 2009. In 2006, Massachusetts expanded access to health insurance to nearly everyone in the state.
They found that there was a small increase overall in the number of ER visits during this time. But they also found that the percentage of visitors who were uninsured dropped from 9.5% to 5.7%. So, more people coming to the ER, more of them with insurance.
In a statement, the lead researcher, Dr. Peter Smulowitz with Beth Israel Deaconess, said he thought the results stemmed from either pent-up demand, or difficulty in accessing primary care:
“Our study should further weaken the long-held notion that high use of the emergency department is driven mainly by the uninsured,” said Dr. Smulowitz. “Barriers to primary care are serious and persistent across the country. It appears that when people have health insurance, they will seek medical care wherever they can get it, which is sometimes only the ER.”
So, have people been waiting to get something taken care of until they got health insurance? Once they got health insurance, did they have trouble finding a primary care doctor?
Another study from Oregon found something similar. So we've got two studies now suggesting that health care reform - the Affordable Care Act, extending health insurance to more Americans - may not necessarily be moving the needle on something we thought it would: reducing the number of costly ER visits made by the uninsured who can't afford care elsewhere. The big hope was that the more people got health insurance, the fewer would need to come to the ER for routine care. That matters because by the time you get to the ER, your condition might be more serious and could have been prevented. But it also matters because of cost. A med school professor put it to me this way once: a doctor's office visit costs $100, an ER visit $1000.
According to these studies, it turns out that it's not just the uninsured who use the ER for health problems that could be taken care of by a primary care doctor or in another outpatient clinic. People with insurance may be using the ER for those kinds of health problems, too. No one's suggesting that there aren't legitimate emergencies represented in this data. But it suggests that people may have been waiting to get some things taken care of, or that they haven't been able to find a regular doctor.
To a lay person like me, the data suggest a few more possibilities.
- We're not as informed as we could be about how to use the health care system and how to take care of ourselves. Perhaps not everyone finds and makes an appointment with a primary care doctor as soon as they get a new insurance card. So when something serious comes up, you've got nowhere to go but a clinic or the ER.
- Perhaps not everyone is able to find a primary care doctor who's taking new patients. In Rhode Island, we've got a pretty good ratio of primary care doctors to population, but they're not all taking new patients.
There's much more to learn about these studies, and I believe it's still too soon to tell how much of an impact expanding insurance coverage will have on ER usage. But the data definitely challenge some long-held assumptions about who is using the ER and why.