Submitted by clevine on Wed, 01/08/2014 – 2:13pm
By: Cathy Levine, Executive Director, UHCAN Ohio
A recently published study showing that expanding Medicaid coverage to people with low incomes increases ER visits has generated news stories feigning surprise, while igniting new attacks on the Affordable Care Act. But the study’s findings are not surprising to anyone familiar with the complicated problem of inappropriate ER use. For more on the study and the flawed analysis of the results, check out this New York Times article.
It’s no surprise: many studies demonstrate that uninsured people delay or avoid needed care and, as a result live with untreated conditions and die sooner than people with coverage. The newly covered people used more primary care – but they also had more ER visits. Why?
The study was based on Oregon’s random expansion of Medicaid, which allowed reliable comparisons of people with and without health coverage After two years, Oregonians with Medicaid had sought health care more often than those with no coverage.
There are several logical reasons why.
1) Many people who are uninsured for substantial time often get used to relying on the emergency room, which becomes their “medical home,” where they are known,treated well, and is easy to find on a bus route.
2) Many newly insured people don’t know about using primary care or where to find primary care.
3) Many people – with private insurance or Medicaid – who develop an urgent problem and can’t get a quick appointment at primary care go to the emergency room instead.
4) Still others – especially people with low-incomes on Medicaid – may avoid primary care clinics or practices if they have felt disrespected or had an unpleasant experience.
People who have long relied on emergency rooms don’t change their habits overnight. It will take a series of strategies to link people with a primary care “medical home” (see, for example, the article on the “Make the Right Call” campaign). But it will also require that primary care practices change their practices to put all patients at the center of care and build partnerships with patients. This includes:
That’s what the “Patient Centered Medical Home” is supposed to be. Community health centers and some community-based practices learned this lesson a long time ago.
One more note: in the media frenzy around this study, there’s lots of loose talk about reducing ER use to reduce unnecessary health care spending. In reality, excessive ER use contributes little or nothing to rising health care costs. For hospitals, running the ER is a fixed cost – the staff is there, lights and heat are on, whether 1 or 100 patients show up. Hospitals are actually building new, fancier ERs to attract patients. When hospitals can make money from developing strategies to divert patients from inappropriate ER visits to their regular primary care provider, more hospitals will engage with community health centers and community organizations on diversion strategies.
Let’s change how providers get paid for health care and we’ll see the system become more patient friendly.