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Study Shows Decline in Emergency Services Use Among Newly Insured

The UCLA Center for Health Policy Research yesterday released a study that lends credence to one of the primary contentions of health care reform — providing health care coverage can reduce expensive emergency department use.

“Once you provide coverage to a population and provide preventive services, particularly for chronic conditions, you can expect a decline in emergency room visits over time,” said Nadereh Pourat, the center’s director of research and lead author of the study.

“In the context of expansion of Medi-Cal and increased health care coverage through the exchange, this is important,” Pourat said. “Everyone is worried about the high cost and use of emergency services.”

The study looked at the California Health Care Coverage Initiative and found over three years that visits to the emergency room declined among newly insured Californians.

Pourat said ED visits increased in the first year of coverage but declined in the following years.
“It makes sense that you might see a bump in use initially, when people first get coverage, but over time you can actually change behavior and change the number of [ED] visits,” Pourat said.

The program didn’t just provide a health insurance card, she said, but also established care coordination through use of the medical home model. Patients in the program had better access, higher quality of care and resulted in stronger safety-net infrastructure, the study said. That helped push the results to show a “significant drop in costly emergency room care,” according to Pourat. 

From a policy perspective the results can be reproduced, Pourat said, “because this population really fit the profile of the newly insured Medi-Cal population [under Medi-Cal expansion]. And it also represents well the lowest income population within the exchange.”

Many people use emergency departments for non-emergencies, or for emergent conditions that are exacerbated by lack of preventive measures to treat chronic conditions, such as diabetes or high blood pressure.

“You should not assume every emergency room visit is necessary,” Pourat said. “Certain visits are urgent, but many aren’t or are preventable. We are positively encouraged because [this study] shows a drop in overall rates, so some of those avoidable visits were reduced.”

Pourat said it’s vital to take that comprehensive approach to care, and to eliminate the other barriers to access.

“My impression is, if you give someone a card, they’re covered, and that is the first step to link them to care,” Pourat said. “But you also have to make sure that care is accessible.”

Pourat said the results of this study certainly apply to implementation of the Affordable Care Act and Medi-Cal expansion, but she added that the central idea can be applied to many types of health programs, such as long-term care efforts, Pourat said.

“The more we can show proof that improving the care process could pay off in the long term,” she said, “that should encourage spreading that policy.”

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