The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform

Miller, Sarah

doi:10.1016/j.jpubeco.2012.07.004

Cited by 205 publications

(208 citation statements)

References 18 publications

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“…38 Analysis of the 2006 health insurance expansion in Massachusetts has found either no effect on ED use 7 or reduced ED use. 23 Recent work highlights that the relationship between insurance and ED use is likely complex and may vary based on the characteristics of the population covered, the nature of the insurance for the newly covered, and the availability of care for the uninsured, among other factors. 20,39 Methodological differences may also be a factor.…”

Section: Discussionmentioning

confidence: 99%

The Uninsured Do Not Use The Emergency Department More—They Use Other Care Less

et al. 2017

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There is a popular perception that insurance coverage will reduce overuse of the emergency department (ED). Both opponents and advocates of expanding insurance coverage under the Affordable Care Act (ACA) have made statements to the effect that EDs have been jammed with the uninsured and that paying for the uninsured population’s emergency care has burdened the health care system as a result of the expense of that care. It has therefore been surprising to many to encounter evidence that insurance coverage increases ED use instead of decreasing it. Two facts may help explain this unexpected finding. First, there is a common misperception that the uninsured use the ED more than the insured. In fact, insured and uninsured adults use the ED at very similar rates and in very similar circumstances—and the uninsured use the ED substantially less than the Medicaid population. Second, while the uninsured do not use the ED more than the insured, they do use other types of care much less than the insured.

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Section: Discussionmentioning

confidence: 99%

The Uninsured Do Not Use The Emergency Department More—They Use Other Care Less

et al. 2017

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“…For example, ED visits in the USA may represent less acute cases as compared with the Netherlands, as ED care more often serves as a substitute for primary care in the USA. 63 We acknowledge that changes in disease burden and changes in medical care are not always easily separated. For example, an increase in healthcare expenditures during the study period 11 may have resulted in or coincided with more active treatment of older adults, and a reduction in age discrimination regarding administration of treatments.…”

Section: Discussionmentioning

confidence: 99%

Trend study on the association between hospital admissions and the health of Dutch older adults (1995–2009)

et al. 2016

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ObjectivesAn increase in hospital admission rates in older people may reflect improved access to healthcare, but also declining health trends in the older population. Owing to a lack of individual-level data, the latter possibility has received little attention. The current study examines associations between health status and hospitalisation rates of older adults in the Netherlands.DesignObservational individual-level data linked to hospital register data.SettingData from 1995 to 2009 from the nationally representative Longitudinal Aging Study Amsterdam were linked to the Dutch Hospital Discharge Register.ParticipantsA total of 5681 observations of 2520 respondents across 4 measurement points (each with a follow-up of 36 months; ages 65–88 years).Outcome measuresThe contribution of health, demographic, psychosocial and lifestyle characteristics to time trends in hospitalisation was assessed in multivariate models.ResultsBetween 1995 and 2009, the percentage with 1 or more overnight admissions (planned or acute) increased slightly from 38.1% to 39.7%. This was due to an increase in acute admission only (22.2–27.0%). Increased prevalences of chronic diseases, functional limitations and polypharmacy accounted for part of the observed increase in acute admissions. In addition, a more than doubled prevalence of day admissions over time was observed (12.3–28.3%), a trend that was unrelated to changes in individual characteristics.ConclusionsThis trend study showed a contribution of declines in population health to increases in acute hospital admissions. Since these declines did not provide a full explanation, healthcare reforms and increases in treatment possibilities in this period are likely to have contributed as well.

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“…Nonetheless, the Massachusetts experience is the most reasonable natural experiment of broad insurance expansion and has been a widely used to forecast effects of the ACA. 2,3,5,6,15,17,18,33 …”

Section: Discussionmentioning

confidence: 99%

“…2–6 For inpatient surgery, investigators have focused on racial disparities and broad aspects of surgical care. However, little is known about the implications of this reform for urological care.…”

Section: Introductionmentioning

confidence: 99%

Anticipating the Impact of Insurance Expansion on Inpatient Urological Surgery

et al. 2014

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PURPOSE The Affordable Care Act (ACA) is expected to provide coverage for nearly twenty-five million previously uninsured individuals. Because the potential impact of the ACA for urological care remains unknown, we estimated the impact of insurance expansion on the utilization of inpatient urological surgeries using Massachusetts (MA) healthcare reform as a natural experiment. METHODS We identified nonelderly patients who underwent inpatient urological surgery from 2003 through 2010 using inpatient databases from MA and two control states. Using July 2007 as the transition point between pre- and post-reform periods, we performed a difference-indifferences (DID) analysis to estimate the effect of insurance expansion on overall and procedure-specific rates of inpatient urological surgery. We also performed subgroup analyses according to race, income and insurance status. RESULTS We identified 1.4 million surgeries performed during the study interval. We observed no change in the overall rate of inpatient urological surgery for the MA population as a whole, but an increase in the rate of inpatient urological surgery for non-white and low income patients. Our DID analysis confirmed these results (all 1.0%, p=0.668; non-whites 9.9%, p=0.006; low income 6.6%, p=0.041). At a procedure level, insurance expansion caused increased rates of inpatient BPH procedures, but had no effect on rates of prostatectomy, cystectomy, nephrectomy, pyeloplasty or PCNL. CONCLUSIONS Insurance expansion in Massachusetts increased the overall rate of inpatient urological surgery only for non-whites and low income patients. These data inform key stakeholders about the potential impact of national insurance expansion for a large segment of urological care.

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The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform

Cited by 205 publications

References 18 publications

The Uninsured Do Not Use The Emergency Department More—They Use Other Care Less

The Uninsured Do Not Use The Emergency Department More—They Use Other Care Less

Trend study on the association between hospital admissions and the health of Dutch older adults (1995–2009)

Anticipating the Impact of Insurance Expansion on Inpatient Urological Surgery

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