Study: Expanding Health Coverage Increases Emergency Room Use

[Gingersnap]

Study: Expanding Health Coverage Increases Emergency Room Use

If the finding holds true, it could undercut an argument for the new health care reform law

By Denver Nicks @DenverNicksJan. 03, 201445 Comments


Expanding health insurance coverage for the poor leads to a significant increase in costly emergency room visits, according to a new study. The finding, published Thursday in the journal Science, raises the possibility of trouble ahead as millions of people gain health insurance through expansion of Medicaid under the new health care reform law, coverage that began kicking in on Wednesday.

The 18-month study followed 25,000 low-income Oregonians who won Medicaid coverage in a lottery as part of the Oregon Health Insurance Experiment, a major policy research initiative. Researchers observed a 40 percent increase in emergency room visits among the newly insured.

According to the study’s authors, the correlation between increased emergency room and expanded health coverage was so strong it held true “across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.”

If it holds true, the study’s central finding threatens to undermine an argument made by proponents of the Affordable Care Act — including President Barack Obama — that the number of costly emergency room visits would decrease if more people had insurance that covered the cost of seeing a primary care doctor.

“I think that it’s very important that we provide coverage for all people because if everybody’s got coverage, then they’re not going to the emergency room for treatment,” Obama said in 2009, according to the New York Times.

An Obama administration spokesperson said the study’s time frame was too short to see behavioral changes in people accustomed to seeking medical care through the emergency room, and pointed to a longer-term study in Massachusetts, which showed expanded coverage led to an eight-percent decline in emergency room use over several years.

Dr. Amitabh Chandra, director of health policy research at the Harvard Kennedy School of Government, called the study’s results “breathtaking” and said that in previous studies the results were too ambiguous to reach a clear conclusion.

“You would conclude what you wanted to conclude depending on which side of political aisle you were on,” he told the Times. “Now we have an answer.”

Under the Affordable Care Act, nearly 25 million Americans could gain health insurance, roughly half of them through Medicaid.

In a move I know will astonish some, I defended the "they'll come around to making appointments" side in a lively conversation at work about this finding. I defended it until a colleague pointed out that she grew up in that same exact culture and no one in their right mind would wait for an appointment when they could be seen almost immediately by going to the ER.

That colleague was talking about being an Army brat and later serving in the military.

She pointed out that since care was free no matter how you accessed it, there was zero incentive to wait and worry. She had a hard time transitioning to regular insurance because of growing up that way. Waiting for days or weeks was just foreign to her mindset.





Read more: Obamacare: Expanding Insurance Could Increase ER Use, Study Says | TIME.com http://swampland.time.com/2014/01/03...#ixzz2pNyhhPF3

[Michele]

I wish he would have just found himself a good therapist after his father kicked him to the curb and his mother abandoned him instead of making us his purpose in his purpose driven life. Transform America? I can hardly wait to be put out of his misery.

[Gingersnap]

I wish he would have just found himself a good therapist after his father kicked him to the curb and his mother abandoned him instead of making us his purpose in his purpose driven life. Transform America? I can hardly wait to be put out of his misery.

LMAO! 'Purpose driven life', indeed!

[Novaheart]

Hospitals need to be given the leeway to divert and retrain the habitual ER abuser. They also need to stop giving away medications to take home. Let hospitals charge meds to the patient's ebt account.

[Gramps]

Hospitals need to be given the leeway to divert and retrain the habitual ER abuser. They also need to stop giving away medications to take home. Let hospitals charge meds to the patient's ebt account.

I have a friend who is EMS.

He has told me repeatedly that they routinely get called and have to transport to the ER for the most mundane shit but they cannot refuse.

The just bill medicaid.

[Adam]

Surprise!

Special Report: Obamacare Causing Crowded Emergency Rooms

FRESNO, Calif. (KMPH) - If you have to go to an emergency room get ready to wait more than five hours.

Right now, that is the average wait in the state of California.

Health experts say you can blame Obamacare and Covered California for that long wait and they say it only going to get worse

One of the promised benefits of the Affordable Care Act was to reduce the pressure on emergency rooms by expanding Medicaid and giving the poor better access to primary care.

But instead, a survey by the American College of Emergency Physicians suggests something else.

The organization says President Obama's health care reform actually has had a destructive effect on the nation's emergency rooms.

American College of Emergency Physicians, Dr. Jay Kaplin says, "Almost half of emergency physicians polled had already seen a rise in their emergency department visits since January one when expanded coverage of the affordable care act took place."

And more E.R. visits mean more crowded waiting rooms.

Locally officials at Saint Agnes Medical Center in Fresno say they've seen a sharp rise in emergency room visits since January 2014.

Community Regional Medical Center in downtown Fresno says it's getting 300 to 400 patients a day in its emergency room.

Defenders of Obamacare, like House Minority Leader Nancy Pelosi suggests, "It's a work in progress."

Others blame a longstanding shortage of primary-care doctors and the fact that some doctors won't accept Medicaid.

Dr. Robert Subers "even if we loved it and wanted to do it, we'd go bankrupt doing it."

Dr. Subers says his office can no longer accept Obamacare patients.

He says the numbers don't lie.

Dr. Subers says he charges roughly $80.00 a visit.

With his expenses for support staff and equipment he says he turns a small profit.

However, Blue Cross Obamacare only pays a doctor $47.00 per patient visit.

That means he'd be paying the insurance company roughly one dollar of his own money to see a patient.

Dr. Subers says, "It was supposed to increase access care, Obamacare was supposed to bring down healthcare costs. I'm trying to see where it's done either."

So what is the answer?

Nearly 9 out of 10 surveyed emergency room doctors believe emergency room visits will only increase by patients over the next 3 to 4 years.

[Frostbit]

I have a friend who is EMS.

He has told me repeatedly that they routinely get called and have to transport to the ER for the most mundane shit but they cannot refuse.

The just bill medicaid.

There are people as well, not many but they exist, that call EMS get transported to the ER then refuse care walking a block to their home. Pretty expensive Taxi for the system.

[Celeste Chalfonte]

As with Ginger's co-worker, people will have to be taught to use the system correctly. Also, hospitals tend to be in accessible locations on public transit lines, while doctors' offices are not always. Kaiser has the one-stop shopping model down to a science: if you show up in the ER with a non-emergency, you're diverted to either Urgent Care or, if it's simply something that has no urgency and you just showed up in hopes of bypassing the appoinment system, they'll send you home if there's no same-day appointments available.

Just because something is free doesn't mean you get to jump the line. People who have Medicaid are accustomed to making appointments to see their welfare worker and other service providers. They can learn, but they won't unless required to.

[RobJohnson]

I have a friend who is EMS.

He has told me repeatedly that they routinely get called and have to transport to the ER for the most mundane shit but they cannot refuse.

The just bill medicaid.

Patients will admit they don't have the gas money to get the doctor or urgent care, so off to ER they go in the bus via 911. I've heard it several times. I personally had to share an ambulance with a person telling the same story while I was having an appendicitis. She was told by Urgent Care to go directly to a hospital in Las Vegas, but did not have the gas money so went to our local hospital to be re-diagnosed and then transported to Vegas. She was able to lay down for the ride sedated with morphine, I had to sit up right feeling every bump in the road while I thought my insides were going to burst and I was not given any medication.

There is another problem, a shortage of doctors and many won't take new patients. The ER has always been the first stop for many Medicaid patients. Now it's simply worse. Some hospitals now have smart phone apps you in which you can check in online before you arrive to expedite your on site wait!

Here is one example, some hospitals have expanded this since the article:

http://www.reviewjournal.com/life/health/smartphone-apps-let-patients-gauge-entry-times-emergency-rooms

[scott]

As with Ginger's co-worker, people will have to be taught to use the system correctly. Also, hospitals tend to be in accessible locations on public transit lines, while doctors' offices are not always. Kaiser has the one-stop shopping model down to a science: if you show up in the ER with a non-emergency, you're diverted to either Urgent Care or, if it's simply something that has no urgency and you just showed up in hopes of bypassing the appoinment system, they'll send you home if there's no same-day appointments available.

Just because something is free doesn't mean you get to jump the line. People who have Medicaid are accustomed to making appointments to see their welfare worker and other service providers. They can learn, but they won't unless required to.

Plenty of Medicaid and Medicare/Medicaid people are not accustomed to making appointments and refuse to do it. The less people pay for healthcare, the more they demand white glove service.

[RobJohnson]

Plenty of Medicaid and Medicare/Medicaid people are not accustomed to making appointments and refuse to do it. The less people pay for healthcare, the more they demand white glove service.

I agree.

[Frostbit]

We worked very hard at Kanakanak Hospital in Dillingham to try and "convert" the Natives to making appointments. There was also a "walk-in" clinic during the day at the same time as the scheduled appointments. I worked two days in walk-in and two days scheduled. Walk-ins was never ending while scheduled days were rarely totally booked (didn't matter which provider). The other day I covered ER for 24 hours. You get a bit grumpy when they bring their 4 year old in for an "ear infection" at 0300 because they were playing pinnacle all day, evening, and into the night. The cost of all three options were the same and could not be altered------- free!

I have about 5 or 6 Native families I follow regularly in my present private practice. They are Dillinghamers that moved over and don't like the "wait" at the Native Hospital. Sometimes over a month to get an appointment and 6-8 hour waits to be seen in the Urgent care. Ironically, they have adapted well to scheduled appointments in the private setting. If they no-show more than two visits I will not allow them to schedule any longer and they can come and wait in the hopes an opening or cancelation occurs. Only had to enforce with one of them.

Without some form of sanction, whether financial or inconvenience, you will not change the mindset of the "entitled".

[Gingersnap]

It could be true that there's a mindset problem when you have "free" care versus an HMO model. People do tend to abuse or misuse services they perceive as free.