Potential Effect of Health Care Reform on Emergency Department Utilization Not Clear

September 23, 2011

Questioning a change in the frequency of hospital emergency department (ED) visits due to the implementation of the Affordable Care Act (ACA), experts have proliferated numerous contradictory predictions and explanations, say Christopher Chen of the Washington University School of Medicine in St. Louis, Gabriel Scheffler of Yale Law School, and Amitabh Chandra of the Kennedy School of Government at Harvard University.

Suggesting that ED visits will increase, some experts cite two separate factors.

  • First, because the ACA will greatly reduce the cost of such visits, injured parties will have less hesitation about having themselves checked out in the emergency room.
  • Second, these experts claim that because the ACA will enable a greater number of people to see physicians, appointments will be more difficult to obtain and ED visits will serve as a fallback.

Other experts claim that greater health care coverage will reduce the frequency of ED utilization: because people will have more access to preventative care, problems will be fixed before they manifest themselves and emergency room visits will be avoided.  Nevertheless, 71 percent of emergency physicians said in 2010 that they expected ED visits to increase.

In order to compare these factors and gain a glimpse at possible end results, researchers recently performed a study of the health care sector in Massachusetts before, during and after its medical insurance reform. 

  • Including both Vermont and New Hampshire to act as controls for general ED visit trends, the study found no conclusive evidence in favor of either argument.
  • Looking at a plot of ED visits over time for the three states, Massachusetts' trend suggests that it has had neither a notable increase not decrease in ED visits.
  • The researchers suggested that this ambiguous result could mean that none of the abovementioned factors are as important as they were made out to be, or, alternatively, the factors on either side exerted equal influence on the frequency of ED visits, causing minimal net change.

These results shed little light on the eventual results of the ACA, but it is at least clear that the answer is not as obvious as some suggest.

Source: Christopher Chen, Gabriel Scheffler and Amitabh Chandra, "Massachusetts' Health Care Reform and Emergency Department Utilization," New England Journal of Medicine, September 7, 2011.

For text:

http://www.nejm.org/doi/full/10.1056/NEJMp1109273#t=article

 

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