National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries

Cheung, Paul; Wiler, Jennifer L.; Lowe, Robert A.; Ginde, Adit A.

doi:10.1016/j.annemergmed.2012.01.035

Cited by 258 publications

(223 citation statements)

References 9 publications

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“…Specific to CVD, lack of insurance is associated with a lower likelihood of adequate treatment of risk factors 85 and with an increased risk of stroke and cardiovascular death. 86 The issue of discrimination limiting access to care has been raised in regard to the difficulties Medicaid patients face in finding regular sources of primary care 87 and access to specialty care. 88,89 In a national study, 87 Medicaid patients were nearly twice as likely to report barriers to obtaining primary care as were patients with private insurance.…”

Section: Affordabilitymentioning

confidence: 99%

Social Determinants of Risk and Outcomes for Cardiovascular Disease

Havranek¹,

Mujahid²,

Barr³

et al. 2015

Circulation

1,101

732

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Section: Affordabilitymentioning

confidence: 99%

Social Determinants of Risk and Outcomes for Cardiovascular Disease

Havranek¹,

Mujahid²,

Barr³

et al. 2015

Circulation

1,101

732

View full text Add to dashboard Cite

“…There is a large body of literature that posits that many problems in the US health care system would be greatly ameliorated if primary care were more readily available to patients 1, 2. The belief is that utilization,3, 4 costs,4, 5, 6 quality,7, 8, 9, 10, 11 and patient satisfaction12 would all improve if better access to primary care could be provided. The process by which these positive outcomes would be achieved is widely accepted.…”

Section: Introductionmentioning

confidence: 99%

The impact of improving access to primary care

Glass

Kanter²,

Jacobsen

et al. 2017

Evaluation Clinical Practice

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ObjectivesTo measure the size and timing of changes in utilization and costs for employees and dependents who had major access barriers to primary care removed, across an 8‐year period (2007 to 2014).Study design and methodsRetrospective observational study examining patterns of utilization and costs before and after the implementation of a worksite medical office in 2010. The worksite office offered convenient primary care services with no travel from work, essentially guaranteed same day access, and no co‐pay. Trends in visit rates and costs were compared for an intervention fixed cohort group (employees and dependents) at the employer (n = 1211) with a control fixed cohort group (n = 542 162) for 6 types of visits (primary, urgent, emergency, inpatient, specialty, and other outpatient). Difference‐in‐differences methods assessed the significance of between‐group changes in utilization and costs.ResultsThe worksite medical office intervention group had an increase in primary care visits relative to the control group (+43% vs +4%, P < 0.001). This was accompanied by a reduction in urgent care visits by the intervention group compared with the control group (−43% vs −5%, P < 0.001). There were no differences in the other types of visits, and the total visit costs for the intervention group increased 5.7% versus 2.7% for the control group (P = 0.008).A sub‐group analysis of the intervention group (comparing dependents to employees) found that that the dependents achieved a reduction in costs of 2.7% (P < 0.001) across the study period.ConclusionsThe potential for long‐term reduction in utilization and costs with better access to primary care is significant, but not easily nor automatically achieved.

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“…Recent studies estimate that between 10% and 30% of ED visits are for nonurgent conditions (3). Such ED utilization has been attributed to barriers in timely and efficient access to primary care, lack of transportation, cost of care, wait times, and opening hours (4)(5)(6)(7)(8)(9). Some studies suggest that patients insured through the Affordable Care Act (ACA) will increase ED utilization rates (10,11).…”

Section: Introductionmentioning

confidence: 99%

“…However, this does not address other barriers to timely and efficient access to primary care, particularly the community-level barriers. Cheung et al observed a direct relationship between the number of barriers faced by Medicaid recipients and ED use (8). In addition, a study by Lowe et al indicated that community characteristics play a significant role in the decision to seek care in the ED (5).…”

Section: Introductionmentioning

confidence: 99%

Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital

Lozano¹,

Ogbu²,

Amin³

et al. 2015

The Journal of Emergency Medicine

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, Abstract-Background: During the past several decades, emergency department (ED) increasing volume has proven to be a difficult challenge to address. With the advent of the Affordable Care Act, there is much speculation on the impact that health care coverage expansion will have on ED usage across the country. It is currently unclear what the effects of Medicaid expansion and a decreased number of uninsured patients will have on ED usage. Objective: We sought to identify the motivators behind ED use in patients who were admitted to a university teaching hospital in order to project the possible impact of health care reform on ED utilization. Methods: We surveyed a convenience sample of uninsured patients who presented to the ED and were subsequently admitted to the inpatient setting. Results: Our respondents sought care in the ED primarily because they perceived their condition to be a medical emergency. Their lack of insurance and associated costs of care resulted in delays in seeking care, in reduced access, and a limited ability to manage chronic health conditions. Thus, contributing to their admission. Conclusions: Affordability will reduce financial barriers to health care insurance coverage. However, efficient and timely access to primary care is a stronger determinant of ED usage in our sample. Health insurance coverage does not guarantee improved health care access. Patients may continue to experience significant challenges in managing chronic health conditions. Ó 2015 Elsevier Inc.

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National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries

Cited by 258 publications

References 9 publications

Social Determinants of Risk and Outcomes for Cardiovascular Disease

Social Determinants of Risk and Outcomes for Cardiovascular Disease

The impact of improving access to primary care

Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital

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