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Dispelling Myths about ER Use by Medicaid Patients

A new study from the Center for Studying Health System Changes provides insight into patient use of the emergency department, some of it dispelling conventional wisdom. Here are some key findings reported:

  • Medicaid patients are not routinely using the ED for non-urgent care. Only about 10% of nonelderly Medicaid patients are using the ED for nonurgent symptoms compared to 7% of the privately insured.
  • Privately insured patients account for most ED use and are driving increases in ED visits over time.
  • Medicaid patients use the ED at roughly double the rate of the privately insured because of their poorer health status – higher illness burden, greater illness severity, and higher rate of severe disability. They also face barriers in accessing primary and specialty care elsewhere and may defer care until it becomes urgent.
  • The study looked at both symptoms causing the ED visit as well as the final diagnoses. Children often have worrisome symptoms accounting for the ED visits, but the diagnoses may turn out to be minor conditions. Acute respiratory/other infections and injuries account for more than half of ED visits by children.
  • Most ED crowding is due to ED boarding, where patients have been admitted to the hospital but are waiting for an inpatient bed.

Policy implications of these findings are discussed:

  • Increasing ED co-payments for Medicaid patients or refusal to pay for some types of ED visits at all may be ineffective, according to recent evidence, and may restrict access to needed care.
  • Patient-centered homes could potentially decrease ED use through improved management of chronic conditions.
  • Encouraging development and use of walk-in or urgent care centers beyond primary care practices may help divert some ED use if they offer expanded hours and the ability to treat a broader array of ailments and minor injuries. However, there is limited information on the participation of these facilities in the Medicaid program. These facilities are less likely to be located in low-income neighborhoods where most Medicaid patients live.

Source: Sommers AS and others. Dispelling myths about emergency department use: majority of Medicaid visits are for urgent or more serious symptoms. Center for Studying Health System Change Research Brief, no. 23, July 2012. http://www.hschange.org/CONTENT/1302/1302.pdf

Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org

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