Medicaid Expansion States See Uptick in ER Visits
Ari Friedman, MD, of Boston’s Beth Israel Deaconess Medical Center, wrote an accompanying editorial and said that the increased ED visits in the expansion states “runs contrary to the prediction by many policymakers that by providing greater access to primary care, insurance expansion would break the decades-long trend of increasing ED volume.”
Friedman said there was scant evidence to support that prediction, but plenty of actual experience from states such as Oregon, which demonstrated that decreasing the cost of healthcare by providing for health insurance leads to an increase in care use of all kinds, be it in the ED or the primary care setting.
“More emergency department visits by Medicaid beneficiaries is neither clearly bad nor clearly good,” Friedman said. “Insurance increases access to care, including emergency department care. We need to move beyond the value judgments that have dominated so much study of emergency department utilization towards a more rational basis for how we structure unscheduled visits in the health system. If we want to meet patients' care needs as patients themselves define them, the emergency department has a key role to play in a flexible system."