Emergency Room Visits Primary Care Access Hospital Finances And Health Outcomes Under Medicaid Expansion

Author : Alina Denham
Publisher :
ISBN 13 :
Total Pages : 262 pages
Book Rating : 4.:/5 (127 download)

DOWNLOAD NOW!

Download or read book Understanding the Impact of the Medicaid Expansion Under the Affordable Care Act on Emergency Department Utilization for Primary Care Sensitive Conditions written by Alina Denham and published by . This book was released on 2021 with total page 262 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation uses consumer choice theory from economics to develop a testable explanation of the increased ED visits phenomenon: whether substitution or complementarity between primary care and ED care for PC treatable conditions explains. This study then compares this economic relationship in the post-expansion period with that before the expansion. To test whether the two types of care are substitutes or complements, non-linear least squares method was used. Next, the effect of the expansion in the cohort of uninsured non-elderly adult ED users who enrolled in Medicaid was estimated using a multi-part modeling approach. For the above analyses, 2012?2015 ED discharge data from New York's Statewide Planning and Research Cooperative System (SPARCS) were used. Effects by working vs non-working hours and by demographic characteristics were estimated using interrupted times series, using data from three states: 2012?2015 SPARCS data for New York and the Healthcare Cost and Utilization Project's (HCUP) State ED Databases (SEDD) for Arizona and Kentucky (2012?2015). This study finds that primary care and ED care for PC treatable conditions were substitutes in New York overall as well as during working hours of PC clinics, but complements during non-working hours in highly urban and poorer counties, after the expansion. This complementarity was not present in the pre-expansion period, where there is strong evidence of substitution across county groups. Consistently across the three states, ED visits for PC sensitive conditions were decreasing before the Medicaid expansion and started to increase after the expansion, particularly among men and younger adult Medicaid enrollees. In the cohort of non-elderly adult ED users that switched from uninsured status to Medicaid coverage, there was a modest increase in ED visits for PC sensitive conditions. These findings elucidate the Medicaid expansion's impact on ED visits for low-acuity conditions, with implications for policies that target high ED use and that aim to expand coverage of low-income populations. Specifically, policy-makers should not assume that increasing PC access will necessarily reduce low-acuity ED visits. More nuanced understanding suggests that policies to decrease low-acuity ED use via PC access improvements in Medicaid will be more effective if they focus on increasing actual appointment availability, ideally by primary care physicians, in areas with low primary care supply. The ability to implement more flexible, targeted policies may depend on funding and resources. Importantly, researchers and policy-makers should recognize that PC access is a broad and multifaceted concept and that different aspects of access may be differently related to low-acuity ED use. As for future expansions of coverage to low-income populations, policy-makers should expect at least short-term (one year) increases in low-acuity ED visits, particularly among men and younger patients.