Medicaid Patients Use ER Services Due To Lack Of Alternative Sources
December 31, 2013

Medicaid Patients Use ER Services Due To Lack Of Alternative Sources

April Flowers for - Your Universe Online

Medicaid insurance patients seeking care in an emergency department might be driven by a lack of alternatives, rather than the acuity of their illness, according to a new study from the University of Colorado School of Medicine.

Roberta Capp, MD, led a team of researchers who studied 4,606 patients and their reasons for seeking emergency care using the 2011 National Health Interview Survey (NHIS). The patients' reasons were classified into two categories: those who used the emergency department because they had trouble accessing care elsewhere, and those who felt they needed immediate medical care. The results of this study were published in the Journal of General Internal Medicine (JGIM).

The key findings of the study included:

* Adults with Medicaid and Medicare were similarly likely to use emergency care due to the severity of the issue, compared to those with private insurance.

* Those with private insurance are less likely to seek emergency care because of access issues than those with Medicaid and those with dual eligibility in Medicaid and Medicare.

* For patients covered by Medicaid insurance, reasons for choosing to use emergency care by health insurance types may be caused more by a lack of access to alternate care instead of differences in patient-perceived acuity.

The researchers suggest policy makers should focus on increasing timely access to primary care. This is especially true for Medicaid recipients. Another necessity, according to the study, is improved care coordination between patients and emergency providers to reduce emergency department utilization. Millions of new patients will be enrolled in Medicaid, due to the Affordable Care Act. This will add to an already overburdened primary care system.

"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," said Capp. "Medicine is complex and patients, no matter what insurance they have, are not always able to determine what is urgent or not urgent."

Capp also notes that Medicaid beneficiaries often mention the inability to get a hold of their primary care providers, get a return phone call or a same day appointment when needed.