Shannon McConville is a senior research associate at the Public Policy Institute of California, in San Francisco.
Maria C. Raven is an assistant professor in the Department of Emergency Medicine and an affiliated faculty member at the Philip R. Lee Institute for Health Policy Studies, both at the University of California San Francisco (UCSF).
Health Aff (Millwood). 2018 Jun;37(6):881-889. doi: 10.1377/hlthaff.2017.0784.
Frequent emergency department (ED) use often serves as a marker for poor access to non-ED ambulatory care. Policy makers and providers hoped that by expanding coverage, the Affordable Care Act (ACA) would curtail frequent ED use. We used data from California's Office of Statewide Health Planning and Development to compare the characteristics of frequent ED users among nonelderly adults in California before and after implementation of several major coverage expansion provisions in the ACA. Frequent users-patients with four or more annual ED visits-accounted for 7.9 percent of ED patients before and 8.5 percent after those provisions were implemented, and they were responsible for 30.7 percent of all visits before and 31.6 percent after. However, after controlling for patient-level characteristics, we found that the odds of being a frequent ED user were significantly lower post ACA for Medicaid-insured patients. Uninsured patients were also less likely to be frequent users post ACA, while privately insured patients experienced little change. The largest predictors of frequent ED use included having a diagnosis of a mental health condition or a substance use disorder. Interventions to address frequent ED use must involve Medicaid managed care plans, given that more than two-thirds of frequent ED users post ACA have Medicaid as their primary coverage source.
频繁使用急诊部(ED)通常是获得非急诊门诊护理机会不足的标志。政策制定者和提供者希望通过扩大覆盖范围,平价医疗法案(ACA)能够减少频繁使用急诊部的情况。我们使用加利福尼亚州全州卫生规划和发展办公室的数据,在平价医疗法案的几项主要覆盖范围扩大条款实施前后,比较了加利福尼亚州非老年成年人中频繁使用急诊部的患者的特征。频繁使用者-每年急诊部就诊四次或以上的患者-在这些条款实施前后分别占急诊部患者的 7.9%和 8.5%,占所有就诊的 30.7%和 31.6%。然而,在控制患者特征后,我们发现,在平价医疗法案实施后,有医疗补助保险的患者成为频繁使用急诊部患者的可能性显著降低。在平价医疗法案实施后,没有保险的患者成为频繁使用急诊部患者的可能性也较低,而私人保险患者的情况变化不大。频繁使用急诊部的最大预测因素包括患有心理健康状况或物质使用障碍的诊断。鉴于超过三分之二的平价医疗法案实施后的频繁使用急诊部的患者将医疗补助作为其主要保险来源,因此必须涉及医疗补助管理式医疗计划来解决频繁使用急诊部的问题。