Exchange Enrollees No More Likely To Seek Costly Care, Data Show
U.S. residents who purchased coverage through the Affordable Care Act's exchanges during its first open enrollment period were no more likely to seek high-cost medical care, countering predictions that such individuals would have more serious medical needs, according to ZocDoc data analyzed by Reuters.
ZocDoc is a no-cost online appointment scheduling tool used by millions of individuals throughout the country (Begley, Reuters, 1/15). The data include information on thousands of users between ages 18 and 64 (Ferris, The Hill, 1/15). People who use the service tend to be younger, female and more technologically skilled than the general U.S. population.
According to the data, individuals with exchange coverage were more likely to schedule regular exams in 2014, such as physicals and well-woman visits, than those who had private health plans, Medicaid coverage or paid for care out-of-pocket last year. According to Reuters, the individuals could have booked more preventive health visits because of pent-up demand. In addition, ZocDoc cofounder and CEO Oliver Kharraz said people with exchange coverage could have been more aware that the ACA requires such services to be provided at no cost than those with other types of coverage.
Meanwhile, the data show that people with exchange coverage were no more likely than others to book appointments with specialists. Kharraz said the data prove that "the vast majority who signed up in the first wave of Obamacare didn't have acute medical needs, contrary to expectations," adding, "The biggest news here is the absence of dramatic utilization differences."
According to the data, individuals with ACA coverage and other types of patients booked appointments with dermatologists and obstetricians/gynecologists the most. Exchange enrollees booked such specialists at a rate 23% higher than other patients, likely for preventive purposes (Reuters, 1/15).
According to The Hill, the data could signal initial success for the Obama administration, which promoted greater access to preventive care as a benefit of the ACA (The Hill, 1/15).
While experts said the data are not surprising, they warned against using the information to draw larger conclusions about health care utilization at such an early stage in the ACA's coverage expansions. Elizabeth Carpenter, head of Avalere Health's health care reform sector, said, "The question is whether, over time, preventive care visits lead to more use of specialists," adding, "Obviously, the more individuals seek preventive care and screenings, the more likely they are to be referred to a specialist" (Reuters, 1/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.