Hospital ER Visits Up Since Mass Health Reform Enacted

To determine whether any changes in ED utilization in Massachusetts reflected the effect of Massachusetts’ reform or were merely representative of broader regional trends in ED utilization, we used New Hampshire and Vermont as control states…

The data on combined inpatient and outpatient ED [Emergency Department] use (top graph) suggest that the Massachusetts reform did not change the state’s trend in total ED utilization relative to that in states where no such reform was enacted. The continuous upward trend in ED utilization throughout the three periods is remarkably consistent from state to state; if we didn’t know which state had implemented the reform law, we could not guess on the basis of these data….. In summary, ED use increased in Massachusetts after reform but also increased by similar amounts in New Hampshire and Vermont, states that did not implement insurance expansions.

NEJM article here.

Comments (5)

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  1. Joe S. says:

    The whole point of the reform was to reduce ER visits.

  2. John R. Graham says:

    Experience informs us that the “free-rider” argument is a myth, and that Medicaid dependents and insured patients, not uninsured people, drive ER care.

    I’d almost be willing to bet that hospitals know this very well. If increased health-insurance coverage led to better preventive care and reduced hospitalization, hospitals would lobby the dickens out of it. Instead, they favor so-called “universal coverage”. This tells us that such a policy is highly unlikely to reduce hospitalization, whether scheduled or unscheduled.

  3. Devon Herrick says:

    The waiting time to see specialists has risen in the past several years in Massachusetts. Physicians increasingly don’t want to accept new patients enrolled in the state-sponsored plans (due to low reimbursement) or ones enrolled in Commonwealth Connector plans (because so few people are insured that way). It would be interesting to see what proportion of ER visits are people with coverage in the Commonwealth or Medicaid.

  4. Tom H. says:

    Amazing graph.

  5. Aaron Ginn says:

    I agree that the free-rider problem is a myth. For example, everyone is hating on Texas for having one of the highest uninsured rates in the country. Yet, our ER visits are mid-pack.

    As well, ER utilization barely changes based on insured status. Maybe it is a myth because everyone has emergencies, regardless of a insurance card.