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Affordable Care Act Increases Reliance on Emergency Rooms

Authors say ERs will need to provide wider range of health-care services

The Patient Protection and Affordable Care Act (PPACA) may have provided health care insurance to an estimated 20 million Americans who lacked coverage, but it has not eased the demand on the nation’s emergency departments. In fact, since the law’s passage, reliance upon the nation’s emergency rooms for non-emergency care has increased.

That’s the finding of a study conducted at the Wayne State University School of Medicine in Detroit, Michigan. The report was published online in the American Journal of Emergency Medicine.

Lead author Alexander Janke, a second-year medical student, noted that Americans who received public insurance under the PPACA now use the emergency room more frequently than before they were insured. The primary reason: Many urban and rural areas of the nation lack primary health-care providers, so the emergency department becomes the only source of health care.

Janke and his colleagues reviewed data from the 2013 National Health Interview Survey, administered by the U.S. Department of Health and Human Services. Their analysis included 7,233 respondents, who reported at least one emergency department visit in the preceding 12 months.

Among emergency room users who reported no usual source of care and who reported relying on the emergency room, 27.7% and 35.1%, respectively, said that a lack of access forced them to the emergency room. None said his or her issue was a true emergency.

Patients lacking a stable usual source of health care were more likely to report using the emergency room because it was their “usual place to get care,” because it was their “closest provider,” or because they “didn’t have another place to go.”

Previous research has shown that Americans who lack access to a usual source of care, such as a family physician, use emergency departments more frequently. The new study, the authors said, is the first population-level investigation to demonstrate their propensity for turning to emergency rooms in the face of a dearth of primary-care access.

Emergency departments, the study said, will need to “evolve into outlets that service a wider range of health care needs rather than function in their current capacity, which is largely to address acute issues in isolation.” Otherwise, the overcrowding of emergency rooms for non-emergency issues will remain problematic.

The study also points out that if newly insured patients cannot access primary care and instead rely upon the emergency rooms, they may not enjoy the full benefits of health care services provided under the PPACA.

Research has shown that poor health and disruptions in access to primary health-care providers are key predictors of emergency room use. The study authors predict that the reliance on emergency rooms will increase as enrollment under the PPACA continues. The trend is troubling because prior research indicates that stable access to primary-care providers is critical for the effective use of health-care services, the authors say. Moreover, studies have found that Americans with an established usual source of care are more likely to follow recommended preventive-care measures, and to demonstrate better rates of awareness, treatment, and control of chronic conditions, such as hypertension and elevated cholesterol levels.

The authors recommend that emergency departments serve as a case study in accessibility, as well as a “fulcrum to contain costs through improved resource utilization.” They recommend new policies that provide incentives for emergency departments to participate in more holistic care for patients lacking a stable usual source of care.

“We are moving toward a more patient-centered and integrated health-care system,” Janke said. “The emergency department has many desirable qualities for patients: accessibility, diagnostic testing, procedures, and a full range of provider expertise. In the paper we say ‘policymakers should provide emergency departments with resources and incentives to better address the full range of their patients’ health care needs, especially as utilization picks up under the Affordable Care Act.’ Emergency departments can coordinate better referral and follow-up, and can address health issues not related to patients’ acute or emergent conditions –– for example, as a checkpoint in long-term hypertension management. Ultimately, though, we will need substantial financial investment to do these things. Emergency department staffs already have plenty to do.”

Source: Wayne State University; December 15, 2014.

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