In the ongoing struggle between reality and the Reality-Based Community, reality strikes again!
Access to Health Care May Increase ER Visits, Study Suggests
Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits as people sought care from primary care doctors. But a rigorous new study conducted in Oregon has flipped that assumption on its head, finding that the newly insured actually went to the emergency room more often.
The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts. The pattern was so strong that it held true across most demographic groups, times of day, and types of visits, including for conditions that were treatable in primary care settings.
The finding casts doubt on the hope that expanded insurance coverage will help rein in rising emergency room costs just as more than two million people are gaining coverage under the Affordable Care Act.
If that sounds familiar, it should:
Medicaid coverage also reduces the costs of going to a primary care doctor, and a previous analysis of data from the Oregon experiment found that such doctor visits also increased substantially. Researchers concluded that gaining health coverage led to an across-the-board rise in the use of health care.
Interestingly, the Times summary of the earlier study included this (my emphasis):
Those with Medicaid were 35 percent more likely to go to a clinic or see a doctor, 15 percent more likely to use prescription drugs and 30 percent more likely to be admitted to a hospital. Researchers were unable to detect a change in emergency room use.
The NBER web page dedicated to Oregon makes the same point about the original study:
Medicaid increased the likelihood of using outpatient care by 35 percent, using prescription drugs by 15 percent, but did not seem to have an effect on use of emergency departments.
I can't explain that seeming discrepancy and time does not permit me to dive in just now. Loose the stat hounds!