One of the goals of the Affordable Care Act was to decrease reliance on emergency rooms by bringing the uninsured into the insurance system. The supposition was that if the uninsured gained coverage, they would seek treatment in other medical settings, rather than wait for an emergency or until a condition became serious to visit an ER. However, so far at least, that supposition isn’t being borne out. US News and World Report:
But findings from the Centers for Disease Control and Prevention suggest that not having health care coverage isn’t the only factor keeping people from defaulting to the ER for care, and that “ER use overall has not changed significantly after the first full year of ACA implementation.”[. . .]
It will be important to see, as the quote notes, whether more time and experience causes the newly insured to limit their ER trips. But for now, this story is a reminder of how extending coverage, while an admirable goal, may not, on its own, may do less to fix U.S. health care than some thought.One can only speculate, but if future data on ER use continues to stay relatively static, one of the relevant factors may be cultural: proactive engagement with the health care system—as opposed to the reactive use of the ER—is something individuals may have to be taught to do and encouraged to follow through on by friends, family, community figures, or other networks of support. Social support systems, including marriage, can correlate with good health outcomes, and encouraging proactive treatment may be one way that communities and relationships can push an individual to healthier behavior. See, for instance, this quote from an NYT piece on falling diabetes rates:
Some say prevention programs have helped keep them on track. Ms. Carpenter, the woman who cut her consumption of Coca-Cola, swears she would not have managed to change her habits without her weekly telephone call from a health counselor and monthly support groups, programs funded by the University of Alabama at Birmingham and the federal government. The meetings are fun, like church socials, she says. In two years, she has missed only one.
Much of our national conversation on health care policy focuses on technical questions of who pays for treatment received and how. These are important—but so are factors like this. Any conversation that leaves the communal aspect of health care out misses something big.