The effect of expanded insurance coverage under the Affordable Care Act on emergency department utilization in New York

Giannouchos, Theodoros V.; Kum, Hye‐Chung; Gary, Jodie C.; Morrisey, Michael A.; Ohsfeldt, Robert L.

doi:10.1016/j.ajem.2021.04.076

Cited by 4 publications

(9 citation statements)

References 46 publications

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“…However, ED visits for potentially preventable, primary care–treatable, and not-emergent conditions made up more than 40% of all ED visits even after states expanded Medicaid. 4 , 5 Although expanding health insurance coverage may be important, it does not guarantee access to medical care. Time and access barriers to outpatient care, such as appointment availability, inconvenient office hours, underinsurance, infrastructure barriers (eg, waiting times and lack of diagnostic capabilities of primary care offices), and prevailing social needs (eg, housing and food instability), are commonly cited reasons for nonemergent presentations to EDs even among insured individuals.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…52 However, ED visits for potentially preventable, primary care-treatable, and not-emergent conditions made up more than 40% of all ED visits even after states expanded Medicaid. 4,5 Although Nonemergent (A), emergent but preventable or avoidable (B), and emergent but primary care-treatable conditions (C). Q1 indicates quarter 1.…”

Section: Expansion States Nonexpansion Statesmentioning

confidence: 99%

“…Time and access barriers to outpatient care, such as appointment availability, inconvenient office hours, underinsurance, infrastructure barriers (eg, waiting times and lack of diagnostic capabilities of primary care offices), and prevailing social needs (eg, housing and food instability), are commonly cited reasons for nonemergent presentations to EDs even among insured individuals. 4,5,9,10,25,33 The high rates of ED visits for not-emergent conditions also raise concerns about the quality of care that some patients receive in primary care and outpatient settings. Dissatisfaction with primary care professionals, language barriers and unclear instructions, physician referrals to the ED, convenient operating hours, and the need for a second opinion are additional factors that predispose ED use.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

“…The use of EDs for nonemergent and preventable medical conditions has been a long-standing challenge in the US health care system. Every year, it is estimated that one-third of all ED visits occur for care that is treatable in primary care settings and preventable . At an average cost that is many times higher compared with treatment provided at a physician’s office or an urgent care center, some of these visits suggest inefficient allocation of resources and present a cost-saving opportunity…”

Section: Introductionmentioning

confidence: 99%

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Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

2022

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Key Points Question Is Medicaid eligibility expansion associated with changes in emergency department (ED) visits based on the medical urgency of the conditions? Findings In this cross-sectional study of 80.6 million ED visits across 4 US states, ED visits per 1000 population decreased for states that expanded Medicaid compared with states that did not. This decrease was associated with decreases in ED visits for less-emergent or nonemergent conditions. Meaning The findings of this study suggest that expanding Medicaid might reduce ED visits for conditions that could be treated in outpatient settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Expansion States Nonexpansion Statesmentioning

confidence: 99%

Section: Jama Network Open | Health Policymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

2022

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Association of the Affordable Care Act with Eye-Related Emergency Department Utilization in the United States

Mir¹,

Mehta²,

Qiang³

et al. 2022

Ophthalmology

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Is the emergency department used as a substitute or a complement to primary care in Medicaid?

Denham,

Hill,

Raven

et al. 2023

HEPL

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Policies to decrease low-acuity emergency department (ED) use have traditionally assumed that EDs are a substitute for unavailable primary care (PC). However, such policies can exacerbate ED overcrowding, rather than ameliorate it, if patients use EDs to complement, rather than substitute, their PC use. We tested whether Medicaid managed care enrolees visit the ED for nonemergent and PC treatable conditions to substitute for or to complement PC. Based on consumer choice theory, we modelled county-level monthly ED visit rate as a function of PC supply and used 2012–2015 New York Statewide Planning and Research Cooperative System (SPARCS) outpatient data and non-linear least squares method to test substitution vs complementarity. In the post-Medicaid expansion period (2014–2015), ED and PC are substitutes state-wide, but are complements in highly urban and poorer counties during nights and weekends. There is no evidence of complementarity before the expansion (2012–2013). Analyses by PC provider demonstrate that the relationship between ED and PC differs depending on whether PC is provided by physicians or advanced practice providers. Policies to reduce low-acuity ED use via improved PC access in Medicaid are likely to be most effective if they focus on increasing actual appointment availability, ideally by physicians, in areas with low PC provider supply. Different aspects of PC access may be differently related to low-acuity ED use.

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The effect of expanded insurance coverage under the Affordable Care Act on emergency department utilization in New York

Cited by 4 publications

References 46 publications

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

Association of Medicaid Expansion With Emergency Department Visits by Medical Urgency

Association of the Affordable Care Act with Eye-Related Emergency Department Utilization in the United States

Is the emergency department used as a substitute or a complement to primary care in Medicaid?

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