I’m still in vacation mode, so I’m not going to do a whole thing on the most recent OHIE analysis, published today, on Medicaid’s effect on ED use. Here’s the abstract:
In 2008, Oregon initiated a limited expansion of a Medicaid program for uninsured, low-income adults, drawing names from a waiting list by lottery. This lottery created a rare opportunity to study the effects of Medicaid coverage using a randomized controlled design. Using the randomization provided by the lottery and emergency-department records from Portland-area hospitals, we study the emergency-department use of about 25,000 lottery participants over approximately 18 months after the lottery. We find that Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. We find increases in emergency-department visits across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.
I’ve written about the OHIE so many times, I’m not wasting time praising it. Let me say that I have no problem believing these results. Unlike many others, I’ve never really believed that increasing insurance coverage leads to less ED use. There are tons of reasons people use the ED over primary care. (See a 2010 post here http://theincidentaleconomist.com/wordpress/when-the-emergency-room-is-your-only-option/).
Improved access will lead to, well, increased access. Emergency room care was never free, no matter what people heard in the media. Telling people that they can NOW go to the emergency room with coverage should lead to MORE people going to the emergency room. Increased access does not always mean decreased spending and more primary care.
Moreover, until someone proves to me that the increased ED use was unnecessary, I don’t know why anyone would assume it’s a bad thing. If our goal is to increase people’s access to the health care system, getting more people insurance (like Medicaid) is a good tool for that. If our goal is to help people make more effective use of the healthcare system, increasing coverage isn’t necessarily going to be as good a tool.
I’m sure there will be a ton of partisan hay made out of this being another “broken promise”, but I’m not participating in that.