Interesting Study On ED Overuse By Medicaid vs Uninsured Patients

Earlier this week I discussed the need to prepare for the onslaught of new patients who will suddenly have insurance coverage. The plan is that they will immediately start using available primary care resources but the reality is that they will continue using the Emergency Department as their primary care provider unless we all take action to redirect this behavior.

A new data brief from the Centers for Disease Control and Prevention presents interesting information that indirectly supports this concern. Their study dismisses the longstanding belief that uninsured patients use the ED much more than privately insured patients. It turns out this is not true which comes as somewhat of a surprise to me. ED use by uninsured patients is only a few percentage points higher than privately insured patients. But Medicaid patients (who would be uninsured without this program) have much higher ED use rates. Medicaid patients in the 45-60 year old range had more than double the ED use rate of other patients. 18-44 year old Medicaid patients also had significantly higher use rates.

On one hand it is surprising to learn that uninsured patients do not necessarily overuse EDs as a primary care provider. On the other hand is is disappointing that patients who have had access to insurance, albeit Medicaid, have continued to use the ED as their entry into the medical system rather than establishing a relationship with a true primary care provider. This just reinforces the fact that we have a lot of work to do in terms of education and accessibility of primary care resources if we want to prevent our EDs from beings overrun with newly insured patients.

I think that Dr. Brokaw's points that I discussed earlier this week are all very valid and this study just reinforces the fact that we need to be proactive in this area.

More on this later.

Mark Brodeur