Study Finds Medicaid Beneficiaries’ Use of Hospital Emergency Departments Comparable to Privately Insured Patients

By Tara Mancini

Medicaid seems to be a lightening rod for inaccurate assumptions such as it’s too expensive for states (it’s a good deal for states), overall cost (more cost-effective than private insurance) and beneficiaries using hospital Emergency Departments for routine care.  Until recently, there had not been much research to refute the perception of Medicaid patients using hospital EDs for non-urgent care.  This summer, a report by the Center for Studying Health System Change looked into the issue and found that non-urgent use of the ED by non-elderly Medicaid patients was NOT disproportionately higher than privately insured patients.

Even when taking into consideration the barriers Medicaid patients encounter when seeking primary care, a research brief by Sommers et al. released in July found that only about 10% of ED visits by non-elderly Medicaid beneficiaries are for non-urgent symptoms.

The same HSC study found that while non-elderly Medicaid beneficiaries do have higher rates of overall ED use when compared with private insurance beneficiaries, only 13% of this difference can be explained by non-urgent visits. Most of the difference between the two groups of patients is due to the poor health status of many Medicaid beneficiaries aged 21-64; partly evidenced by the their higher rates in seeking care for multiple medical conditions as well as for injuries. The researchers suggest the former may be the result of barriers to primary and specialty care, and the latter due to a higher percentage of disability among Medicaid beneficiaries.

Sommers et al., put forth some ideas to alleviate the burden felt by hospital EDs; greater adoption of patient-centered medical homes (PCMH) by providers, creating more capacity to care for a high-volume of urgent medical problems in lower cost settings, and broader payment reforms, such as ACOs, that move away from fee-for-service. Citing evidence of its ineffectiveness, instituting co-pays is not an idea that they champion.