A study published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals, reveals that newly insured and newly uninsured adults are more likely to go to the emergency department (ED) due to recent changes in health insurance status. The report is part of the journal’s Health Care Reform series.

The hospital ED is a significant indicator for access to care. According to the researchers, newly insured and newly uninsured individuals can find it hard to access outpatient care, and as a result may turn to hospital EDs in order to receive medical care.

The research team led by Adit A. Ginde, M.D., M.P.H., of the University of Colorado School of Medicine, Aurora, examined 159,934 respondents to the 2004-2009 National Health Interview Study, a cross-sectional household interview of a sample that approximates the non-institutionalized U.S. civilian population.

The researchers found that during the previous 12 months:

  • 20.7% of insured adults went to the ED at least one time vs. 20% of uninsured adults
  • 20.2% of continuously insured adults had at least one ED visit vs. 29.5% of newly insured adults (currently insured but were uninsured at some period during the previous 12 months)
  • 18.6% of continuously uninsured adults had a least one ED visit vs. 25.7% of newly uninsured adults (currently uninsured but who had insurance at some period during the prior 12 months)

They authors explain:

“In conclusion, although adjusted ED use rates were similar for insured adults and uninsured adults, those with recent changes in health insurance status had greater ED use. Adults with new Medicaid coverage were disproportionately likely to use EDs, suggesting that their reduced out-of-pocket cost for care was not associated with increased access to primary care services.”

The authors write that by 2019, health insurance coverage in the U.S. is expected to increase by up to 94% following the implementation of the 2010 Patient Protection and Affordable Care Act. The coverage will mainly be through Medicaid or Medicaid-like insurance.

Results from the study indicate that people who currently don’t have health insurance but did so in previous 12 months were also more likely to visit the ED as they may experience a sudden decrease in their access to care.

The researchers conclude:

“Because health policy changes and economic forces are expected to create disruptions in health insurance status, policy makers and health care administrators should anticipate new surges in ED use.

Consistency in provision and health insurance type may improve access to primary care services and reduce patient reliance on ED services.”

In an associated report, Mitchell H. Katz, M.D., of the Los Angeles County Department of Health Services, California, said:

“With EDs already overcrowded, it is of great concern what will happen when insurance coverage is expanded under the provisions of the Patient Protection and Affordable Care Act.”

Katz continues:

“Indeed, one reason why the uninsured now use the ED is that under the federal Emergency Medical Treatment and Labor Act, patients who go to a hospital ED cannot be denied care because of inability to pay. No such obligation exists in physician’s offices or other outpatient settings, in which patients who cannot pay are routinely turned away.”

Katz concludes:

“The ED should not be the default option because other places are not open or are open only to those with the right billfold. Before the insurance expansion occurs, we need to expand the capacity and capability of primary care, including extended hours and same-day appointments, so that EDs can do their job of triaging and caring for the acutely ill or injured.”

Written by Grace Rattue