Medicaid patients in California increased their use of emergency departments by 35.6% over a 5-year period while use by privately insured patients barely increased.
"Increasing ED use by Medicaid beneficiaries could reflect decreasing access to primary care, which is supported by our findings of high and increasing rates of ED use for ambulatory care sensitive conditions by Medicaid patients," wrote Dr. Renee Hsia. The report was published in the Sept. 18 issue of JAMA.
Dr. Hsia of the University of California, San Francisco, and her coauthors examined rates of ED utilization in California from 2005 to 2010 and broke down the data by insurance status (JAMA 2013;310:1181-81). They looked at adult patients younger than 65 years, because these patients "have experienced the greatest changes in insurance coverage in recent years, and are likely to see the biggest shifts as a result of health care reform."
The investigators based their retrospective analysis on the California Office of Statewide Health Planning and Development’s Emergency Discharge Data and Patient Discharge Data. The study grouped patients by insurance status: Medicaid, private, uninsured or self-pay, or other (workers compensation, CHAMPUS/TRICARE, Title V, and Veterans Affairs, and similar coverage).
Overall, ED visits jumped from 5.4 million to 6.1 million over the 5-year period – a 13% increase. While visits for patients with private insurance barely increased, with a 5-year difference of just 1%, visits by Medicaid patients increased by 35.6%, and visits by uninsured patients rose 25.4%. Visits by patients with coverage in the "other" category decreased by more than 10%, the authors noted.
Medicaid patients also maintained the highest rate of visits such as hypertension, which are potentially preventable with primary care. Among Medicaid recipients, the average yearly rate of ED visits for these problems was 54.76/1,000, compared with 10.93/1,000 for those with private insurance and 16.6/1,000 for those who were uninsured.
These visits showed the same kinds of coverage-dependent increases over the study period: a 6.8% hike among Medicaid beneficiaries and 6.2% among the uninsured, but a decline of 0.7% among privately insured patients.
Neither Dr. Hsia nor her coauthors reported any financial disclosures.