Expanding Medicaid Coverage Ups Emergency Department Use
(HealthDay News) – Expanding Medicaid coverage is associated with increased emergency department use, according to a study published online Jan. 2 in Science.
A selection of eligible individuals for enrollment in Medicaid was made based on a lottery drawing as part of the 2008 Oregon Health Insurance Experiment. Sarah L. Taubman, ScD, from the National Bureau of Economic Research in Cambridge, MA, and colleagues followed about 25,000 of these participants over approximately 18 months to examine the effects of Medicaid coverage on emergency department use.
The researchers found that Medicaid coverage correlated with significant increases in overall emergency use (0.41 visits per person; P<0.001), a 40% increase relative to an average of 1.02 visits per person in the control group. Increases in emergency department visits were consistent across a range of types of visit, with significant increases noted in all classifications except the emergent, non-preventable category; increases were most notable in visits classified as "primary care treatable" (0.18 visits; P<0.001) and "non-emergent" (0.12 visits; P=0.001). Increases were consistent across a range of conditions (including headaches, injuries, and chronic conditions) and subgroups.
"We find that expanding Medicaid coverage increases emergency department use across a broad range of visit types, including visits that may be most readily treatable in other outpatient settings," the authors write. "These findings speak to one cost of expanding Medicaid, as well as its net effect on the efficiency of care delivered, and may thus be a useful input for informed decision-making balancing the costs and benefits of expanding Medicaid."