Increased ER use among newly insured: Oregon Health Insurance Experiment

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1. ER utilization increased by 40.8% within the first 18 months of gaining health insurance.

2. Visits to the ER for non-emergent and primary care treatable events were significantly higher in the newly insured population.

Evidence Rating Level: 2 (Good)

Study Rundown: Researchers found that compared to uninsured, those who gained insurance increased ER visits by 40.8% (SE=0.12; p<0.001). Drilling down to the specific diagnosis code, researchers were also able to determine that the newly insured population had a significantly greater number of visits to the ER that were either primary care treatable or non-emergent.

Across the country this study is receiving significant media coverage with headlines warning of ER’s bursting with newly insured patient loads; however it may be a hasty conclusion. The 18-month duration of the study may have been too short for the population to find a permanent primary care provider. This adjustment away from the ER may take time and may require more resources to navigate people toward more appropriate ways to access care. This study is valuable and should be used by communities and hospitals to help prepare for immediate changes occurring nationwide, but should not necessarily be extrapolated to interpret long-term trends.

Click to read the study in Science

Relevant Reading: Massachusetts’ health care reform and emergency department utilization

In-Depth [retrospective analysis]: In 2008 the Oregon government decided to expand Medicaid through an lottery system by granting access to health coverage for 30,000 individual randomly selected out of a larger 90,000 person pool. This program provided near perfect conditions for a randomized controlled study for researchers to investigate how gaining health insurance – as an isolated event – influences health outcomes and utilization. In this study researchers compared utilization of ER among the newly insured and uninsured control group over an 18 month time frame. In addition to the overall increase in utilization, researchers also identified increases in non-emergent (0.12 visits; SE=0.04; p=0.001) and primary care treatable (0.18 visits; SE=.05; p<0.001) events presenting at the ER.

By Jordan Anderson and Andrew Bishara

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