Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study

Abstract

BACKGROUND: Shopping for health insurance is encouraged as a way to find the most affordable coverage that best meets an enrollee's needs. However, the extent to which individuals switch insurance and subsequent changes in health care utilization that might arise, particularly new physician visits, are not well understood. OBJECTIVE: To examine the relationship between insurance switching and new physician and emergency department visits around the time of a switch. DESIGN: Observational study using a difference-indifferences design to compare those switching insurance carriers with propensity score-matched controls who did not switch, stratified based on whether individuals initially had private or Medicaid insurance coverage. All analyses adjusted for individual and insurance characteristics. PARTICIPANTS: Continuously insured, non-elderly individuals with private or Medicaid insurance coverage in Massachusetts from 2010 to 2013. MAIN MEASURES: Rates of new primary care and specialist physician visits, as well as rates of emergency department visits. KEY RESULTS: Before matching, among 1,628,057 continuously insured individuals, 418,231 (26%) switched insurance carriers during a 2-year period. Characteristics of switchers and non-switchers were similar after matching (n = 316,343 in each group). After matching, switching plans was associated with a 203% and 47.5% increase in the rate of new primary care physician visits following switching for those initially with Medicaid or private coverage, respectively (both p < 0.001), with a large shortterm increase, diminishing over time. Among those with Medicaid coverage, switching was associated with a 14.9% higher rate of ED visits during the month of switching (p < 0.001), but otherwise decreased modestly after switching. CONCLUSIONS: Insurance switching is common, and is associated with increased new physician visits and temporarily increased ED use among the publicly insured. As insurance markets become more volatile in the current policy environment, understanding changes in utilization after insurance switching may become increasingly important.

Insurance instability and use of emergency and office-based care after gaining coverage: An observational cohort study

“…persist for future years. For example, previous work has shown that large increases in new patient primary care visits among those switching payers and plans diminish over time [34]. We find compelling evidence that expanding coverage to the long-term uninsured yields significant increases in health care use, but not necessarily the desired substitution from the ED to office-based settings.…”

“…Similarly, we do not know if the changes that we observe will persist for future years. For example, previous work has shown that large increases in new patient primary care visits among those switching payers and plans diminish over time [ 34 ].…”

Breadth and Exclusivity of Hospital and Physician Networks in US Insurance Markets

“…This concern is motivated by research documenting noteworthy disruptions in care and an increased reliance on emergency departments associated with changes in insurance plans. [13][14][15][16] Narrow network plans have also been shown to have lower annual limits on patient out-of-pocket spending and prohibitions on annual and lifetime insurer spending maximums-apply to nearly all private health insurance plans but only for care received by in-network clinicians and hospitals. Given these considerations, it is important to know whether patients will be able to affordably maintain preferred clinical relationships if and when they change insurance plans.…”

Validation of an Algorithm for Claims-based Incidence of Prostate Cancer

“…[18] The observation time for the men in our study is similar to other commercial health plans, so similar baseline periods should be available in other claims environments. [21] Failure to identify prostate cancer cases in claims was primarily due to a time interval between biopsy and prostate cancer diagnosis longer than 28 days. Previous literature reports use of a similar, though not validated, algorithm that required biopsy and ICD-9 diagnosis, but with a time interval of up to 3 months.…”