Emergency room visits have been on the rise in Massachusetts since the passage of the 2006 health law, much to the chagrin of supporters who projected that the opposite would happen as more people had insurance and were connected with primary care providers. A new study published online by the Annals of Emergency Medicine shows that the issue may be a bit more nuanced.
While overall emergency room visits increased about 4.1 percent between 2006 and 2008, visits among patients who are poor or uninsured using the emergency room for "low-severity" issues fell slightly, by about 1.8 percent.
The number is small but significant, according to the authors. It represents a slight step in the right direction. But it also provides a reality check, said lead author Dr. Peter Smulowitz, an emergency physician at Beth Israel Deaconess Medical Center.
Smulowitz said the 2006 law has done just what it was designed to do - expand health insurance - but its success has been unfairly measured by emergency room usage. The idea that the law has failed if it hasn't reduced those visits is "nonsensical," he said. The reasons why people go to an ER versus a primary care doctor are complex and subject to social conditions and people's perceptions of the seriousness of their problem. The availability of primary care physicians in off hours and on short notice is also a major driver.
The finding that even for more minor issues like strep throat and sprained ankles, few people with access to insurance are bypassing the emergency room in favor of a primary care office, should "dispel the notion that providing health insurance will suddenly make (emergency departments) obsolete," he said.
The researchers looked at billing data for about 578,000 emergency room visits to 11 hospitals during the year before the law took effect in 2006 and two years afterward.
Massachusetts Institute of Technology economist Jonathan Gruber said some people who avoided emergency rooms because they were too expensive in the earlier period may be using them more now that they have coverage, offsetting the progress of moving some people into primary care practices. He said more work is needed to deter people from using the ER through higher copayments or programs that target chronic users.
“I think the lesson here is you don’t save as much on emergency rooms as you’d think from universal coverage," he said. "It’s not clear why.”
About white coat notes
|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at email@example.com. Follow her on Twitter: @cconaboy.|
Gideon Gil, Health and Science Editor
Elizabeth Comeau, Senior Health Producer