Study says the newly insured visit ER more often
- Article by: Sabrina Tavernise
- New York Times
- January 2, 2014 - 7:18 PM
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 was true across most demographic groups, times of day and types of visits, including for issues 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 2 million people are gaining coverage under the Affordable Care Act.
Instead, the study suggests that the surge in the numbers of insured people might put even greater pressure on emergency rooms and increase costs. Nearly 30 million uninsured Americans could gain coverage under the law, about half of them through Medicaid.
“I suspect that the finding will be surprising to many in the policy debate,” said Katherine Baicker, an economist at Harvard University’s School of Public Health and one of the authors of the study.
But Baicker and other economists who worked on the study said the increased use of emergency rooms was driven by a basic economic principle: When things or services get cheaper, people buy and use more of them.
Previous studies have found that uninsured people face out-of-pocket costs that can put them in debt when they go to the emergency room, and that Medicaid reduces those costs.
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.
“This is just one piece of an increase we found across every type of care,” said Bill J. Wright, an author of the new study who is the associate director of the Center for Outcomes Research and Education in Portland.
Some experts said that the pattern identified in the new study could shift over time.
“How to use a plan and when to seek emergency department care involves a learning curve that doesn’t happen overnight,” said Sara Rosenbaum, a health researcher at George Washington University who was not involved in the study.
Amitabh Chandra, director of health policy research at the Harvard Kennedy School of Government, also said that people might often be using the emergency room because they need its services. Medicine has become much more complex since the days when people relied mainly on a family doctor, he said.
“We often say, ‘If this person had just received preventative care at a doctor’s office, we would not have seen emergency room use,’ ” said Chandra, who was not involved in the study. “But there is only so much that prevention can do.”
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