Hospital use probably won’t rise due to Medicare for all

With Medicare for all on the lips of many Democratic presidential candidates and public support for universal healthcare coverage at its highest ever, concerns about healthcare usage under such a system have arisen.

However, hospital use isn’t likely to rise under a Medicare-for-all plan, according to research published in the Annals of Internal Medicine.

The assumption that Medicare for all will lead to higher usage of hospital facilities stems from the fact that those with comprehensive health insurance tend to use hospital care more than those who are uninsured or have a high-deductible healthcare plan.

Harvard researchers wanted to know the likelihood of increased hospital usage and looked at the implementations of Medicare and Medicaid in 1966 and the Affordable Care Act in 2014 to determine how hospital use was affected. Participants in the study included respondents to the National Health Interview Survey conducted between 1962 and 1970 and the Medical Expenditure Panel Survey from 2008 to 2015.

The program implementations represent the largest expansions in government-sponsored healthcare in the U.S.

What they found was an overall hospital discharge rate of 12.8 per 100 persons in the three years leading up to the implementation of Medicare and Medicaid, and a rate of 12.7 discharges per 100 persons in the four years after. Hospital days increased after the first two years of implementation and varied by subpopulation. For example, the elderly and lower-income persons used the hospital more, but usage among younger and higher-income persons declined.

Similarly, researchers found “no evidence that hospital use increased in the wake of the ACA,” lead author Adam Gaffrey, MD, MPH, of the Cambridge Health Alliance and Harvard Medical School, and colleagues wrote.

Researchers suggested that a limited supply of hospital beds actually limited the increase in use.

“Past coverage expansions were associated with little or no change in society-wide hospital use; increases in groups who gained coverage were offset by reductions among others, suggesting that bed supply limited increases in use,” Gaffrey et al. wrote.

However, if funding for hospitals increases over time, usage of this care could go up, researchers surmised.