It's a myth the uninsured use the ER more often, study shows
Correction: In a previous version of this article, the University of Illinois was listed instead of the University of Chicago as contributing research.
- A new Health Affairs paper Tuesday found that the often-cited belief that uninsured individuals utilize the emergency room (ER) more often may be inaccurate.
- The Harvard, Massachusetts Institute of Technology and University of Chicago researchers found that in 2013, 12.2% of uninsured adults made an emergency department (ED) visits, while 13.7% of insured adults visited. At the same time, 29.3% of adults on Medicaid logged at least one visit to the ED.
- But uninsured adults used significantly less outpatient care than the insured: Uninsured adults averaged two outpatient visits per year while insured adults logged six on average.
A common argument for expanding health insurance coverage is that it is one tool to reduce costly ER visits and more appropriately shift care to primary and preventative care.
But this assumption does not appear to hold up: The authors cite the Oregon Health Insurance Experiment, which expanded Medicaid to cover uninsured working-age adults. The experiment found that expanding coverage resulted in increased ER use as well as other healthcare services.
The researchers found that the type of care administered during ED visits did not significantly vary among the uninsured and insured. The uninsured and insured both used the ED in the same way: approximately one-fifth visited for conditions that were likely nonemergency, and a third of both groups visited for a condition that was possibly treatable in a different healthcare setting.
But the authors say the enduring perception that the uninsured use the ED more often may be attributable to the fact that they receive less outpatient care compared to those insured.
“The key distinction in care use, therefore, is the relative paucity of use of non-ED care—such as in clinics or hospitals—by the uninsured compared to the insured. This reflects both financial and non-financial access barriers encountered by the uninsured. The Emergency Medical Treatment and Labor Act (EMTALA) provides the uninsured with a legal right to care through the ED, although it does not protect them against the financial consequences of expensive ED visits. The uninsured, however, may be legally denied care in non-ED settings,” the authors wrote.
But John Graves, assistant professor of health policy at Vanderbilt University, warned on Twitter that the new Health Affairs paper’s usage of payer data to determine insurance status may mask the uninsured. Hospitals may be presumptively enrolling uninsured individuals who are eligible for Medicaid, he said.
Really like this study, but one limitation here is the use of payer to determine insurance status.— John Graves (@johngraves9) December 5, 2017
This may mask presumptive enrollment of uninsured at hospital, which would reconcile the anecdote/myth with these data. https://t.co/1jtRhw3Nbk
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