Posted by: AtlasMD

January 2, 2014

Study Suggests More Insurance, More ER Visits

Sabrina Tavernise writes in The New York Times about a new study that flips a steadfast assumption on its head. At first glance, you’d think that giving people more access to Medicaid would lower the frequency of ER visits. However, a study conducted in Oregon has proven the exact opposite.

The study was published in the journal Science. It compared two groups of people — a 2008 lottery randomly selected thousands of low-income people in the Portland area and provided them Medicaid coverage; a second group entered the lottery but received no insurance. Here’s the shocker. “Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts,” writes The Times. The pattern was strong, holding true across most demographics, times of day, and types of visits. These even included conditions that we could have treated here in our Atlas MD office.


And of course everything in healthcare gets filtered through the ACA prism. Our administration believed they could cut ER costs (one of myriad factors causing American healthcare prices to soar) by expanding insurance coverage. Ideally, millions will gain insurance coverage under the Affordable Care Act. But now the study indicates that this could cause a surge in the number of people showing up to the ER.

“I suspect that the finding will be surprising to many in the policy debate,” said Katherine Baicker, an economist at Harvard University’s School of Public Health and one of the authors of the study.

In a nutshell, more red tape has caused more ER visits. Why? Dr. Baicker attributes the increased use of emergency rooms to a basic economic principle: Cheaper services mean more sales. Basically, if Medicaid reduces the cost of ER visits, more people will go to the ER. But did more people go the primary care docs? Actually they did. The Times writes, “Medicaid coverage also reduces the costs of going to a primary care doctor, and a previous analysis of data from the Oregon experiment found that such doctor visits also increased substantially.” The conclusion is that gaining health coverage leads to more usage of health care overall.

Experts cautioned that the new study’s findings could shift over time, though. The study only measured the first 18 months after people gained coverage, and there is suspicion that people’s habit of relying on the emergency room might factor into the increased visits. It also takes time to find a primary care doctor and make an appointment. Seriously, seeing a primary care doctor can be a real pain. Plus, docs dealing with insurance only get compensated for line items. More tests mean more potential revenue, regardless of whether patients actually need the test. And on top of that, prices are majorly obscured, meaning that sticker shock can talk people out of seeing a doctor — EVEN WHEN THEY HAVE INSURANCE.

What’s our take on the findings? Expect the unexpected. You would think that more insurance coverage means more doc visits and therefore lower prices overall. However, we’re talking about red tape here. Depending on people’s political/ideological leanings, you can get all kinds of predictions. But what’s most worrisome is the mixed logic of our own administration. They argue that more coverage means lower prices, and therefore more care. However, they fail to see how their involvement makes it less of a “free market” and therefore less like the economy postulated by economist Adam Smith.

And don’t forget the elephant in the room — QUALITY CARE. Currently, the U.S. faces a primary care physician shortage that is predicted to grow. And doctors are getting burnt out. Unfortunately, there’s nothing in Obamacare that’s geared toward actually improving the quality of care (although you’ll see the phrase all over this list of Obamacare’s Key Features). And there’s NOTHING that addresses doctors’ statuses. In fact, this statement concerns us:

Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010.

At a glance, this sounds cool. But from a doc’s perspective this means trouble. The procedure might be free to the patient, but will require additional work for the doctor in order to get paid.

Considering the triple aim — improving health care quality, improving overall health, and lowering per capita cost — there’s not much to get excited about. Yes, a portion of the population might have “access” to health coverage. And that means they might be able to go to the doctor more. But it’s hard to believe that these visits will be of high quality. And they’re definitely not cheaper by any means. Check out this list of taxes that are helping to fund Obamacare.