Despite Implementation of the Affordable Care Act, the Rate of ED Visits Hasn’t Changed
BY JEFF BAUER
FROM THE NATIONAL CENTER FOR HEALTH STATISTICS
A recent report from the National Center for Health Statistics (NCHS) found that approximately one of every five US adults visited an ED at least once in 2014—the first year core elements of the Affordable Care Act (ACA) were implemented. This is virtually the same rate as in 2013.
The NCHS report used data from the National Health Interview Survey, which is a multipurpose health survey of US adults who are not in the military and are not institutionalized. The Centers for Disease Control and Prevention (CDC) conducts this survey continuously and uses the same questions year after year. The current report included data on 26,825 adults ages 18 to 64 years in 2013 and 28,053 in 2014. The overall response rate was 62.1% in 2013 and 58.9% in 2014.
Overall, 18% of adults visited an ED one or more times in 2014, compared to 18.2% in 2013. In both years, 11.4% reported just one visit. The report also asked respondents the reason for their ED visit. In 2014, 77% of respondents said the seriousness of the medical problem was the reason for their visit, 12% because their doctor’s office was not open, 7% because of a lack of access to other clinicians, and 4% gave no reason. These percentages were similar in 2013.
This report also compared the rate of ED visits based on type of insurance coverage (see “Medicaid Recipients Are Much More Likely to Visit the ED” below).
This new report comes on the heels of a March 2015 American College of Emergency Physicians poll of almost 2,100 emergency physicians regarding the volume of ED visits. In that poll, 75% of respondents said that since January 2014, when the ACA required individuals to have health insurance, the volume of ED visits increased slightly (reported by 47%) or increased greatly (reported by 28%).
1. Gindi RM, Black LI, Cohe RA. Reasons for emergency room use among U.S. adults aged 18-64: National Health Interview Survey, 2013 and 2014. http://www.cdc.gov/nchs/data/nhsr/nhsr090.pdf. Accessed April 22, 2016.
Medicaid Recipients Are Much More Likely to Visit the ED
BY RICHARD FRANKI
FRONTLINE MEDICAL NEWS
Adults ages 18 to 64 years with Medicaid coverage were almost twice as likely as all adults to visit the ED in 2014, according to a report from the NCHS.
In 2014, an estimated 35.2% of Medicaid recipients ages 18 to 64 visited the ED at least once, and more than half of those (18.5%) made two or more visits. Among all adults ages 18 to 64 years, 18.0% made at least one ED visit, while 6.6% made two or more visits. In 2014, 14.3% of adults ages 18 to 64 years with private insurance made one or more ED visits, as did 16.6% of those who were uninsured, the NCHS reported.
Compared with 2013, adults with ED visits were down slightly for all adults (18.2% to 18.0%), up slightly for those with private insurance (14.0% to 14.3%), and down for those with Medicaid (37.7% to 35.2%) and the uninsured (18.5% to 16.6%), the report showed.
There was a significant decrease for uninsured adults with two or more visits from 8.0% in 2013 to 5.9% in 2014 (P < .05), and the drop among Medicaid recipients with one ED visit from 19% in 2013 to 16.7% in 2014 was significant at P < .1, the NCHS noted.
The highest rates of ED use among adults have consistently been associated “with public health coverage such as Medicaid, relative to adults who were uninsured or had private health insurance. This higher rate of use may be related to more serious medical needs in the Medicaid population,” the NCHS investigators said.
Younger individuals (ages 18-29 years) were more likely to visit the ED, with 20.2% having at least one visit in 2014, compared with 16.8% of those ages 30 to 44 years and 17.5% of those ages 45 to 64 years. There also were differences by race and ethnicity, as 26.5% of non-Hispanic blacks made one or more ED visits in 2014, compared with 17.5% of non-Hispanic whites and 15.7% of Hispanics, according to the report, which was based on data from the National Health Interview Survey.
1. Gindi RM, Black LI, Cohen RA. Reasons for emergency room use among U.S. adults aged 18–64: National Health Interview Survey, 2013 and 2014. http://www.cdc.gov/nchs/data/nhsr/nhsr090.pdf. Accessed April 22, 2016.