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Reforming Delivery
Emergency Room Use Thwarts Health Reform

Here’s what critics mean when they say the Affordable Care Act is simply cementing the dysfunctional U.S. health care status quo: two new studies suggest emergency room use is spiking in the wake of the law’s expansion of insurance coverage. First, the Colorado Hospital Association looked at 450 hospitals across 25 states and found that states that expanded Medicaid saw average ER use go up by 5.6 percent over the same period last year—three times more than states that did not expand. That may not seem like a lot, but if those patients had used urgent care clinics or community health centers instead, the difference in cost would have amounted to some significant savings.

This finding is consistent with a second study just released—this one on the young adults. Stanford University researchers found that young adults whom the ACA allows to stay on their parents insurance for longer treat the ER as a primary care setting, via WaPo.  The researchers compared those under 26, who could stay on their parents’ insurance, with those over 26, who could not. They found that though overall number of ER visits were two percent lower for the older group who didn’t get the expansion, the same number of people overall used the ER in both groups:

 The distinction here is that young adults with chronic conditions, who have greater care needs, probably now had better access to non-ER care settings, so their number of visits to the ER decreased. But the finding also suggests that healthy young adults, who might have shunned health insurance before, still continued to see the ER as a place for seeking out routine care, according to the study. Further, insurance likely makes those ER visits cheaper, which could actually increase how much people use the ER, the researchers wrote.

But everyone agrees that in an ideal health-care system, the ER wouldn’t be a place for routine care.

Expanding insurance coverage is a worthy policy aim but unless we change how and, crucially, where patients receive care, we will be stuck with a system much more expensive and less efficient than it could be.

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  • Corlyss

    Isn’t “Where is the emergency room?” the second English phrase the Raza activists tell their illegals to learn in English? No. 1 would be “I am a refugee from gangs and drug cartels that will kill me if you don’t let me mooch off your generosity” or words to that effect . . .

  • Andrew Allison

    There’s more to this than meets the eye. Expanded Medicaid obviously encourages ER usage by those unwilling or unable to find a service provider willing to accept Medicaid reimbursement; but even subsidized ACA has high deductibles and co-pays, a disincentive for the insured to use the ER for routine care.

  • B-Sabre

    There was a recent discussion on NPR on how ACA is impacting free clinics – apparently more of them are going out of operation because they can’t afford the operational and adminstrative overhead imposed by the ACA, and their former clients are caught in a trap: ACA has forced their former low-cost provider out of business, but with the high deductibles and narrow coverage of the ACA mandated insurance, they can’t afford to go to another provider. Three guesses where they end up, and it rhymes with “urgency groom”.
    The Law of Unintended Consequences strikes again!

  • John Stephens

    Is there a law that requires hospitals to maintain an Emergency Room? What would happen if they stopped?

  • Jane the Actuary

    The expansion of health insurance doesn’t do anything to improve access to healthcare providers on an after-hours basis, for those sorts of healthcare needs that could, in principle, be handled outside the ER but there’s no actual opportunity to do so.

    A while back, my son got a bad splinter in his foot over the weekend — too far in for us to handle at home. We actually went to what we believed was an “urgent care” facility (we were out-of-town) but it turned out to be an ER that also handled “urgent care” cases, yet determined, based on the particulars, whether it was an “urgent care” or “ER” treatment and charged accordingly. Unfortunately for us, it was deemed to be an ER treatment.

    If, on top of this, we imagine that the formerly uninsured are not just careless but don’t have primary care doctors or, more significantly, don’t have as much flexibility to see a doctor during their limited business hours, and the Walgreen’s-type clinics are great, but there are significant limits to what they can do, then it makes perfect sense that they continue to use the ER.

    Here’s an idea: why can’t hospitals transform the ER into a true combined ER and Urgent Care clinic, in which patients are triaged to the right spot and can have their healthcare needs met without paying all the ER overhead when it’s not needed?

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