States should expect more people to use emergency departments after the Affordable Care Act is fully implemented, say the authors of a new study reporting increases in emergency care visits in Massachusetts during and after the state’s own similar reforms went into effect.
The study, published online today in the Annals of Emergency Medicine, analyzed all emergency department visits in Massachusetts between October 1, 2004, and September 30, 2009. The data included records from 69 hospitals, accounting for some 2 million annual outpatient emergency visits, 850 000 inpatient admissions, and 150 000 observation stays. Reforms that expanded health care access in the state were implemented between October 1, 2006, and September 30, 2007.
Compared with the 2-year period before reforms started to go into effect, emergency department visits increased by up to 1.2% during the 1-year implementation and by up to 2.2% during the 2-year period after reforms were fully in effect.
Uninsured patients younger than 65 years accounted for 9.5% of all emergency department visits before implementation but 5.7% afterward. The data showed that emergency department use increased among several insured groups.
Insured white patients younger than 65 years accounted for 62.7% of emergency visits before reforms went into effect and 64.2% afterward. In the same age group, insured black patients accounted for 12% of emergency visits before the reforms and 13.9% afterward. The largest increase was among Medicaid patients younger than 65 years, who accounted for 23.6% of emergency department patients before the reforms went into effect compared with 29.7% afterward.
“This study should further weaken the long-held notion that high use of the [emergency department] is being driven mainly by the uninsured,” the authors wrote.
They also noted that their results are similar to those recently reported by Oregon researchers, who found that adults included in a 2008 Medicaid expansion made more emergency department visits than those who weren’t included.
Several factors drive these trends, the Annals authors wrote. They named transportation, ability to take time off from work or find child care, emergency departments’ 24-hour availability, limited availability of primary care services, distances between the emergency department and a primary care physician, and the perceived efficiency and expertise of emergency departments.
“Our study suggests that other states should be prepared for equal or greater influxes of patients into the [emergency department] after health care reform is fully implemented,” the authors wrote.