Examining the Link Between Emergency Department Use and Insurance Coverage

The use of emergency departments (EDs) for health care in the United States has undergone significant changes in recent years due to the implementation of the Patient Protection and Affordable Care Act (ACA). This act has led to an increase in the number of Medicaid-insured residents and a decrease in the percentage of uninsured individuals in California. To understand how these changes in insurance coverage have affected the ED landscape, a cohort study was conducted to examine trends in ED visits and insurance coverage in California from 2011 to 2019.

A study analyzed public ED visit data from the California Department of Healthcare Access and Information and population data from the State Health Access Data Assistance Center. The analysis included all ED visits categorized by payer, including Medicare, Medicaid, private insurance, uninsured, or other. Visit rates were determined using California population data stratified by insurance coverage.

The findings of the study revealed that the overall number of ED visits in California increased from 2011 to 2019, surpassing population growth. Medicaid-covered visits showed the most significant increase, comprising 41.5% of all ED visits in 2019. The number of Medicaid beneficiaries also increased substantially during this period. In contrast, uninsured visits decreased, while visits covered by Medicare and private insurance remained relatively stable.

When considering both the number of ED visits and population size, overall ED visit rates in California increased significantly from 2011 to 2019. The visit rate for Medicaid showed the largest increase among all payer groups, followed by uninsured visits. Medicaid had the highest visit rate in 2019, surpassing even Medicare. The privately insured visit rate was the lowest.

The study highlights the dual impact that EDs are facing due to the changes in insurance coverage: a larger Medicaid population and increased rates of ED use. While Medicaid expansion has provided increased health care coverage for previously uninsured individuals, it has also led to increased health care utilization and public spending. Additionally, the limited availability of primary care physicians in the US continues to pose challenges for accessing primary care, contributing to the increased reliance on EDs.

It is important to note that this study was limited to California and used administrative data, which may not be generalizable to other regions. Nevertheless, these findings can inform policymakers and health care stakeholders in making decisions regarding resource allocation in health care. The study emphasizes the need for addressing the underlying factors contributing to increased ED use and promoting better access to primary care for Medicaid beneficiaries and uninsured individuals.

Reference:
Hsia RY, Feldmeier M, Sarkar N. Trends in Payer Type for Emergency Department Visits in California, 2011-2019. JAMA Netw Open. 2023;6(4):e2310321. Published 2023 Apr 3. doi:10.1001/jamanetworkopen.2023.10321