Oregon medicaid report and use of the hospital ER
The current buzz revolves around a study suggesting increased access to health care by medicaid recipients may actually increase visits to the ER, not decrease them as the White house claims.
The people at The Incidental Economist tackle the issues A few thoughts on the latest Oregon Medicaid results, the latest results aren’t actually counter intuitive and increased ER use isn’t necessarily bad.
I wonder if there is any indication they seek treatment earlier even if in the ER, and whether that may result in lower costs, e.g. outpatient rather than inpatient. Probably not enough data to say.
TIE raises interesting questions about how much of a hassle getting an appointment can be for the poor. I’d throw out there that there are also semi-urgent conditions that may go away on their own without an ER visit but could result in an ER visit from someone who is covered. For example, a baby with an ear infection might end up in the ER because a pediatrician might only have open appointments 4 or 5 weeks in the future, but an uninsured parent might just wait that one out, hoping that the ear infection clears up on its own, if they know they’ll be stuck with a $10,000 bill.
Also too, this study has only gone on for a couple of years. The efficacy of preventative care increases with the amount of time one has had access to it. Having a doctor tell you you’re diabetic a week before losing a foot isn’t as useful as the doctor telling you you’re pre-diabetic and still have a few years to prevent diabetes through a change in diet.
Hospitals do not necessarily dislike ER traffic, as long as there is enough revenue to cover the variable costs and contribute something to fixed costs.
The biggest problems is the “randomness of traffic” problem, it is difficult to predict who will show up and when.
Lord, great question.
Obviously access to a primary care physician and a care network is preferable, but any access is an improvement.
Rusty, “…but any access is an improvement.” I thought they always had access to the ER. To me it appears it results in a shift in costs. Who is now refunding the ER costs? Depending on income it appears to be shared with lowest incomes totally paid by the tax payers. No Change. But as we go up in income the taxpayers funding is reduced and paid for by individuals. That is a change, but I still don’t see any change in access.
It still needs to be resolved that access to private Drs is improved with expansion in Medicaid. time will tell.
There was access, but lack of compensation made the ER a drain on other services and required creative cost shifting.
Paid access, even with low rates, makes the hospital healthier and maybe allows more thorough care.
Ultimately, a better primary care network is the solution.
Rusty, thanks. I thought I remembered that the costs were reimbursed. Wrong again.
As I understand it, once the uninsured got insurance, they simply went to the place they were used to going to receive care: the ER. There has now been a concerted effort to change this habit to seeking care via non-hospital based/ER service.
Thus, the report is not necessarily a problem regarding hospital ER’s.
Just a hunch, but I have heard repeatedly that many physicians will not accept Medicaid patients. I don’t know of any requirement compelling a physician to provide service to a specific patient, even if the criteria is financial. So those who have been using ER care for general medical treatment have no choice but to continue to do so. They will now have less hassle from the hospital’s billing department.
The whole piece raises a question, of why the hospitals don’t have clinics attached, for urgent and routine care. Even the hospital House is associated with seems to have a clinic which he tries to avoid, because routine work boors him. However if you provide a clinic, no appointments needed say from 7an to 9 pm, on the same campus as the ER, and have the triage nurses at the ER refer folks there who don’t need the full ER, it would work. The key would it would be like the various urgent care clinics around first come first served.
Daniel – right, but this is going to take some time.
Lyle – many hospitals are trying variations of your strategy, both beside the ER and off campus
Jack – you are somewhat correct but it is more complicated
The one missing element in Obamacare is a bold stroke to enhance primary care availability.
Many years ago the health ministry in Cuba studied how people used health care, and found that working class people were much more likely to use the emergency room than middle class Cubans, even though no money changed hands. The reasons for this were two: first, working class Cubans felt less comfortable dealing with medical professionals, finding them judgmental and unsympathetic. The second reason was that working class Cubans waited longer than the middle-class to seek medical help (see above), and therefore were likely to need it more immediately or in the middle of the night.