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26-03-2012 | Legal medicine | Article

Health insurance status changes linked to increased emergency department use

Abstract

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MedWire news: Patients who have recently undergone a change in their health insurance status are more likely to seek emergency department (ED) care, say researchers.

Adit Ginde (University of Colorado School of Medicine, Aurora, USA) and colleagues found that newly insured and newly uninsured people can experience difficulty accessing outpatient care and instead go through hospital emergency departments to receive care.

In a study published in the Archives of Internal Medicine, they analyzed the responses of 158,934 adults to the 2004-2009 National Health Interview Survey.

The researchers found that, overall, 20.7% of insured adults and 20% of uninsured adults had made at least one vist to an ED during the past 12 months. Comparison of those who were currently insured or uninsured, and those who had undergone a change in their health insurance status at some point in the past 12 months, with continuously insured or uninsured adults revealed significant differences in ED use. Specifically, 29.5% of newly insured adults had at least one ED visit compared with 20.2% of continuously insured adults, and 25.7% of newly uninsured adults compared with 18.6% of continuously uninsured adults had at least one ED visit.

Ginde and colleagues explain that uninsured individuals are typically blamed for rising pressure on ED services, whereas their results suggest that disruptions in healthcare insurance status may instead be responsible.

"In theory, newly insured adults should have new access to primary care services for acute and preventive care needs, resulting in a decreased need for ED services; however, our results indicate increased use of ED services," the research team comment.

"One possible explanation is that, during the prior uninsured state, individuals may necessarily defer care, leading to a period of increased 'catch-up' use of healthcare services. Also, reducing the financial barrier to care by obtaining health insurance without addressing other barriers to primary care may encourage patients to use the ED when there is a lack of access to other sites of care."

In an accompanying editorial, Mitchell Katz of the Los Angeles County Department of Health Services, California, USA, writes that 16 million uninsured people are estimated to gain Medicaid coverage, and a further 16 million will gain coverage through a subsidized insurance exchange, when insurance coverage is expanded under the Patient Protection and Affordable Care Act.

He adds that in light of the findings of Ginde et al, "before the insurance expansion occurs, we need to expand the capacity and capability of primary care, including extended hours and same-day appointments, so that EDs can do their job of triaging and caring for the acutely ill or injured."

By Chloe McIvor

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