Defying expectations, greater insurance coverage is linked to increased ED use

The hope that universal health insurance coverage will move healthcare delivery out of costly care settings like emergency departments and into lower-cost primary care settings may not come true unless other barriers to primary care access also are addressed finds a new study.

Researchers from Beth Israel Deaconess Medical Center in Boston, Dartmouth University, Harvard Medical School and the Massachusetts Institute of Technology examined emergency department use in Massachusetts after the state enacted a universal health insurance coverage law in 2006 similar to the Federal Patient Protection and Affordable Care Act. They compared areas of the state that were minimally affected by the new law because most residents already had health insurance coverage in those communities to areas of the state where more people became insured for the first time due to the law.

This was the first time that statewide data had been examined, and what the researchers found was that emergency department use went up in the areas of the state that were more affected by the implementation of the law contradicting the belief that lack of insurance is a primary factor in driving up inappropriate emergency department visits. Rather, what the researchers saw was that unless other barriers to primary care were addressed, the newly insured would be slightly more likely to use the emergency department for care than they had been when they were uninsured.

The researchers noted that while more studies are needed, some likely barriers to primary care included a shortage of primary care providers and long wait times for appointments, as well as a lack of convenient primary care hours. For example, some of the newly insured held jobs that did not easily allow taking time off for medical care during the day. Others lacked daytime childcare. 

“These results carry significant implications … for states planning for the impending effect of national healthcare reform,” the authors wrote.

They noted that other states will have even greater shortages of primary care providers than Massachusetts and should be ready for an uptick in emergency department use as uninsured residents obtain coverage under the Affordable Care Act.

The study, "Increased Use of the Emergency Department After Health Care Reform in Massachusetts," was published online ahead of print by the Annals of Emergency Medicine.

 

Lena Kauffman,

Contributor

Lena Kauffman is a contributing writer based in Ann Arbor, Michigan.

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