Blog | Thursday, March 29, 2012

QD: News Every Day--Change in insurance coverage leads to more ER use


People visit the emergency room more often when they shift either direction from insured to noninsured status, a study found.

With so much potential for millions to gain or lose insurance coverage through legislation, court decisions or the still recovering economy, it's worth a look at what might potentially drive emergency room traffic, researchers noted.

They analyzed 159,934 adult respondents to the National Health Interview Survey from 2004 to 2009. The study found 7.8% of the population changed insurance coverage in the past year. Results appeared in the March 26 issue of Archives of Internal Medicine.

Overall, 20.7% of insured adults and 20% of uninsured adults had at least one emergency department visit. The resulting "churning" of insurance coverage was associated with 29.5% of newly insured adults compared with 20.2% of continuously insured adults had at least emergency visit. Similarly, 25.7% of newly uninsured adults compared with 18.6% of continuously uninsured adults had at least one emergency visit.

After adjusting variables, a change in insurance was associated with greater emergency department use for newly insured adults (incidence rate ratio [IRR], 1.32; 95% confidence interval [CI], 1.22 to 1.42 vs. continuously insured adults) and for newly uninsured adults (IRR, 1.39; 95% CI, 1.26 to 1.54 vs. continuously uninsured adults). Among newly insured adults, this association was strongest for Medicaid beneficiaries (IRR, 1.45) but was attenuated for those with private insurance (IRR, 1.24) (P less than .001 for interaction).

An editorialist noted that, as the emergency department is only place in the health care system that cannot refuse treatment, "The newly uninsured likely went to the ED for continuation of whatever treatment they had been receiving. Also, some of the newly uninsured may have lost their insurance because of a new illness, and this group may have used the ED more than the continuously uninsured because they were more ill."