New Jersey researchers link income decline to increased ER use

Patients' income affects the likelihood they will unnecessarily seek care at hospitals instead of doctor's offices or clinics, according to a new study by the Rutgers Center for State Health Policy.

Researchers  discovered that for every 1 percent increase in per capita income among New Jersey residents, there was a nearly 1 percent decrease in avoidable hospital visits. The researchers analyzed 13 regions and related hospital costs and utilization throughout the Garden State to reach their conclusion.

"Per capita income is the most important driver of avoidable hospital utilization and costs," the report said.

The city of Camden, one of the poorest in the entire U.S., had huge emergency room (ER) usage rates predicted by the relatively low income of their residents, Rutgers Professor Derek DeLia told New Jersey Spotlight.

"[I]nterventions that focus more directly on the problems associated with poverty and other socioeconomic disadvantages, such as initiatives to expand safe and stable housing or address substance abuse, would likely produce greater benefit than changes in traditional healthcare delivery per se," the report states.

Unnecessary ER visits by lower-income Americans have been a problem for U.S. hospitals for years, particularly before the expansion of Medicaid and the private insurance market under the Affordable Care Act, although some studies have indicated that Medicaid enrollees are more likely to use the ER. Some states, such as Washington, have even gone so far as to try and curb such unnecessary visits by limiting Medicaid enrollees to no more than three ER visits in a calendar year.

However, the report also criticized excess capacity of hospital beds. It concluded in regions of New Jersey where there was excess capacity, admissions were more likely.

"Hospitals with excess capacity have a clear financial incentive to fill empty beds, especially when they are reimbursed on a fee-for-service basis," the report said.

To learn more:
- read the N.J. Spotlight article
- check out the study (.pdf)

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