Study: Health care for poor doesn’t reduce ER visits

Long before there was Obamacare, an underpinning of the health care debate in the United States has almost always been that with health care, people won’t use much-more-expensive emergency rooms at hospitals for primary medical care.

That’s now disproven, according to a study published today in Science.

Oregon studied what happened in 2008 when the state expanded health care coverage to the working poor. The random selection of participants allowed investigators to conduct a more scientifically rigorous study than would otherwise normally be possible, Scientific American reports.

When the investigators compared households that were newly eligible for Medicaid insurance coverage with their counterparts who “lost out” on the lottery, they found that the number of emergency room visits increased by an average of 40 percent. Indeed, nearly every category of emergency room visit saw an increase—from visits during normal daytime hours during the week to visits for things that could just as easily been taken care of in a doctor’s office. The one category that did not increase was visits to the emergency room for true emergencies.

Presumably, the lower cost of emergency room visits for the newly insured made it easier for them to choose the service. Still unknown is whether this was a temporary effect that will even out over time.

“How to use a plan and when to seek emergency department care involves a learning curve that doesn’t happen overnight,” Sara Rosenbaum, a health researcher at George Washington University who was not involved in the study, tells the New York Times.

Ray Fisman, who writes The Dismal Science blog at Slate isn’t ready to use the study to declare health care is built on sand…

In my policy comment accompanying the current study, I express hope that these results will not simply lead to further bickering and greater divisiveness on the question of whether we should expand insurance coverage. Both sides of the Obamacare debate took the first two studies from the Oregon experiment as evidence in support of their opposing causes, and it’s easy to imagine the same response to the results reported in Thursday’s study. Health care proponents will point to the findings as evidence that ERs are now serving the suppressed medical needs of the uninsured, people who were previously scared away from getting any care for fear of financial. Opponents will see yet more evidence that when you make health care too cheap (i.e., free), people use too much of it.

More constructively, we could take the study as a compelling indication that ER usage—which we can all agree isn’t the most efficient way of caring for scrapes and sprains—is likely to go up, not down, as the Affordable Care Act leads to wider insurance coverage, and prepare for that outcome. Regardless of how you feel about the ACA, this study should demand a greater sense of urgency for such preparations.