Study Debunks Claims That Medicaid Patients Abuse Emergency Rooms

Opponents of Medicaid expansion have often distorted reports of increase Emergency Room use after their expansion of the Medicaid program in Oregon as reason to oppose the program. MACPAC, a nonpartisan federal agency that provides policy and data analysis on Medicaid and CHIP to Congress, has found the problem to not be as serious as suggested as the vast majority of the use of Emergency Rooms is for valid reasons. Fierce Health Finance summarized their findings:

The Medicaid population uses hospital emergency departments (EDs) at a higher rate than patients with other forms of insurance, but for the most part such visits are necessary, according to a new report from the Medicaid and CHIP Payment and Advisory Commission (MACPAC).

The report aims to debunk the notion that Medicaid patients show up at the emergency room (ER) for care because they have been conditioned to do so. “The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention,” the report said. It noted that Medicaid patients tend to have much higher rates of chronic diseases and debilitating conditions than those in the privately insured population, or even among those who lack health insurance altogether. In many cases, their conditions are so compromised that even their primary care physicians will refer them to the ER.

Moreover, MACPAC also engaged in a systematic review of all the research regarding ED use and the Medicaid population between 1990 and 2010. It concluded that there was no “consistent association” between Medicaid enrollees and unnecessary ER use.

MACPAC also noted that some conditions treated at the ER that are classified as non-urgent  are best treated there anyway. “Some problems, such as chest pain in a 50-year old or an infant’s fever and rash, carry high risks for patients and are best evaluated in an ED,” the report said. “This is true even if–after a physician’s evaluation and some rapid testing–the vast majority of cases are resolved.”

Experience from Medicaid expansion in Ohio also showed that better management of the Medicaid patients can lead to better control of chronic disease while limiting Emergency Room use.

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