Medicaid beneficiaries seek ER care due to lack of options

Patients with Medicaid insurance often seek health care in an emergency department due to a lack of alternative care options, rather than the severity of their illness, according to study results recently published in the Journal of General Internal Medicine.

Using the 2011 National Health Interview Survey, researchers asked 4,606 patients whose last emergency department visit did not result in hospitalization about their reasons for seeking care in the emergency department. Patient responses were classified into two categories: those who used the emergency department for immediate evaluation (acuity issues) or those who used the emergency department due to barriers preventing them from accessing outpatient services.

Researchers analyzed data to test the association between health insurance type and reasons for ED visits, while adjusting for sociodemographic characteristics.

Study results showed 65% of patients reported one or more acuity issues and 78.9% reported one or more access issues. Researchers found among those who reported no acuity issues leading to the most recent emergency department visit, 84.2% of patients reported one or more access issues. Patients with Medicaid or Medicare were just as likely to seek emergency department care due to acuity issues compared with patients who had private insurance. However, patients with Medicaid and patients with both Medicaid and Medicare were more likely than those with private insurance to seek emergency department care because they could not find an alternative health care option, according to study results.

Researchers believe policy makers should focus on increasing timely access to primary care, especially for Medicaid beneficiaries, and improving care coordination between patients and emergency care providers.

“There is a misconception that patients with Medicaid insurance are more likely to use emergency rooms for a non-urgent issue when compared with those who have private insurance,” Roberta Capp, MD, MHS, of the department of emergency medicine at the University of Colorado School of Medicine and the Robert Wood Johnson Foundation-Clinical Scholars and department of emergency medicine at Yale School of Medicine, stated in a press release. “Medicine is complex and patients, no matter what insurance they have, are not always able to determine what is urgent or not urgent.”

For more information:

Capp R. J Gen Intern Med. 2013;doi:10.1007/s11606-013-2734-4.

Disclosure: Capp has no relevant financial disclosures.

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