Study predicts how insurance expansion affects ambulatory care

Expanding insurance coverage through the Affordable Care Act may result in more outpatient clinic visits and unchanged emergency room use, according to researchers at the University of Michigan Medical School.

The national study examined the effects of the state-administered Children's Health Insurance Program (CHIP) as a representation of new national health insurance. Researchers analyzed patterns of emergency and routine outpatient visits by adolescents age 11 to 18 and young adults age 19 to 29.

Without evaluating the need for ER visits, the study compared adolescent use of ER and outpatient services with that of young adults four years before and 10 years after CHIP launched. Most states didn't enroll young adults in CHIP, making them an apt comparison group for a pre-Affordable Care Act experience.     

The findings include:     

  • Adolescent outpatient visits increased after CHIP's implementation, but there was no comparable rise in young adult outpatient utilization.
  • There was no significant post-CHIP change in the mean number of adolescent ER visits, but young adult ER use rose by 48 visits per 1,000 persons.
  • The ratio of outpatient-to-ER visits rose for adolescents but fell for young adults.

Since this ratio shows the balance between types of care settings, it may help measure results of health insurance reforms.

"Looking at both emergency department visits and outpatient visits together is important," lead researcher Adrianne N. Haggins, M.D., M.S. said in the research announcement. "When we're thinking about access to healthcare and insurance reform, insurers and hospitals cannot solely focus on limiting the number of emergency visits. We have to make sure there's adequate access to alternative outpatient care."

Outpatient capacity limits affect care access. Added Haggins: "If a newly-insured patient has a hard time finding a provider who would accept their insurance or getting appointments with ones who will, there is a real possibility that we will continue to see them go to the emergency department." 

To learn more:
- read the research announcement from the University of Michigan
- see the study abstract

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