Puzzle of the Day: Medicaid Expansion and Unavoidable Emergency Department Visits
To paraphrase John Wayne, evaluating health care is hard. It is even harder if you use percentages.
A 2011 report on whether or not Wisconsin’s BadgerCare’s coverage of childless adults affected their utilization of services concluded that people in a sample of about 10,000 very low income childless Milwaukee adults increased their total emergency department visits by 39 percent when they were newly enrolled in Medicaid coverage.
Seventeen percent of visits resulted in a hospital admission before Medicaid was expanded to cover the group. After expansion, 9.5 percent of emergency department visits resulted in a hospital admission.
The report spins this like it was a good outcome: “This significant 45% decline is notable in that Wisconsin Medicaid payment policy considers an ED visit ‘appropriate’ when it results in a hospital admission.” Later on, the report reminded readers that “the percentage of hospital admissions from the emergency department declined dramatically.”
This is playing games with arithmetic — Table 2 shows that the number of emergency department visits considered unavoidable, or not treatable by primary care, did not change significantly. Sixty-two percent of the increased visits were from patients with non-emergent conditions, while 38 percent were from increased accidents and similar events. The number of injuries, presumably another unavoidable reason to go to the emergency department, was unaccountably grouped with visits due to excessive alcohol and drug consumption.
When overall visits increase but unavoidable visits stay the same, unavoidable visits as a percentage of the total will decrease. This provides little support for the proposition that Medicaid expansion reduces hospital admissions from the emergency department.
People with no insurance have long known that they can be treated in the ED any time of day or night for any condition, and will not be turned away for inability to pay. The theory behind all of the sweeping “healthcare reform” is that having insurance will encourage the treatment of non-emergent conditions in the clinic instead. I’m not sure this will change anything in the near future.
People will not go to the clinic as a substitute for ER care. ER is quicker and cannot deny patients, while under ObamaCare, clinic wait times will likely be through the roof.
Pardon me for my denseness, but does this study just show that newly enrolled Medicaid enrollees over utilize expensive ERs versus less costly urgent care centers where they should have been treated? And 10,000 population over 1 year doesn’t seem to make a statistically valid trend (from 17% to almost 10%). Seems like other factors could have come into play over that 12 month period. My .02.
Well yeah. If I’m getting Medicaid, I’ll take the extra expensive and quicker option then waiting for a visit. It’s not like they are paying for it.
You guys are making more sense than most of the articles in the medical journals combined!
Exactly right Devon and Perry! People newly covered by Medicaid are rational enough to adjust their behavior according to the increased incentives to visit the ER for non-justifiable reasons. Yet another “unintended consequence” of the Medicaid expansion under the ACA.
Yes: There was a big increase in accidents, but that was separated as a factor. I wonder if Medicaid coverage also makes you reckless? (That’s an off-the-cuff remark, but there may be something to it.)
Free health care woo! *crash*
Which is why Medicaid expansion is bad for limiting ER visits. It’s been known this would happen for a while…