ERs to see more visits with changes in health insurance status

With the individual mandate on the chopping block this week, a new Archives of Internal Medicine study found that adults who either gained or lost health insurance are more likely to use the emergency department, compared to those who are consistently insured or uninsured. The study suggests two things: (1) not surprisingly, newly uninsured individuals used the ED because of a sudden decrease in access to care, and (2) as many had feared, newly insured patients (such as those under health reform) went to the ED instead of using primary care services.

Researchers from the University of Colorado School of Medicine and Oregon Health and Science University found one-fifth (20.7 percent) of insured adults and 20 percent of uninsured adults had at least one ED visit during the previous 12 months, overall. Taking into account a change in health insurance status, 29.5 percent of newly insured patients (currently insured but lacked health insurance at some point during the prior 12 months) visited the ED at least once in the past year, compared with 20.2 percent of continuously insured adults. The pattern also occurred in newly uninsured. More than one-quarter (25.7 percent) of adults who lost health insurance went to the ED in the past year, compared with 18.6 percent of continuously uninsured adults.

The study may suggest a lose-lose situation, especially as millions of Americans are expected to change their health insurance status in 2014 under health reform.

"We're already overcrowded. There's already long wait times and patient safety risks associated with that," study author Adit Ginde, a Colorado University assistant professor of emergency medicine, said in a Denver Business Journal article. "So, if we're at the breaking point right now and we start adding more visits, you can imagine where that would lead as far as just breaking."

The authors wrote that policy makers and healthcare administrators should anticipate new floods of patients to the ED but suggested ways to minimize ED use. "Consistency in provision and health insurance type may improve access to primary care services and reduce patient reliance on ED services."

During the past decade, hospitals already have seen a 35 percent increase in ED visits, Ginde told the Denver Business Journal. If upheld, 32 million Americans will become newly insured under the individual insurance mandate in 2014.

For more information:
- read the press release
- check out the study abstract
- read the Denver Business Journal article

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