Article

Copayments did not reduce medicaid enrollees' nonemergency use of emergency departments.

Department of Health Services Administration, School of Public Health, University of Maryland, College Park, MD, USA.
Health Affairs (Impact Factor: 4.64). 09/2010; 29(9):1643-50. DOI: 10.1377/hlthaff.2009.0906
Source: PubMed

ABSTRACT Eager to reduce unnecessary use of hospital emergency departments by Medicaid enrollees, states are increasingly implementing cost sharing for nonemergency visits. This paper uses monthly data from the 2001-2006 Medical Expenditure Panel Surveys (MEPS) to examine how changes in nine states' copayment policies influence enrollees' use of emergency departments. The results suggest that requiring copayments for nonemergency visits did not decrease emergency department use by Medicaid enrollees. Future research should examine more closely the effects at the state level and investigate whether these copayments affected the use of other services, such as hospitalizations or visits to physicians by Medicaid enrollees.

0 Bookmarks
 · 
87 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 2006, Idaho and Kentucky became two of the first states to implement changes to their Medicaid programs under authority granted by the 2005 Deficit Reduction Act (DRA). The DRA granted new flexibility in the design of state Medicaid programs, including a state plan amendment (SPA) option for changes that previously would have required a waiver. This paper uses state Medicaid administrative data to analyze the impact of Medicaid policy changes implemented in these states through a series of SPAs in 2006 and 2007. Changes in utilization are examined for multiple services, including physician, dental, and ER visits, inpatient stays, and prescriptions, among non-elderly adult Medicaid recipients following changes in cost sharing, reimbursement, service delivery, and covered services. Where possible, enrollees not affected by the changes served as a comparison group. While relatively few adults in Idaho received a wellness exam after such coverage was added, the adoption of managed care for dental services was associated with increased receipt of dental care, including preventive care. The new limits on brand name prescriptions in Kentucky were associated with a reduction in the proportion of enrollees with two or more monthly name brand prescriptions while the small copayments introduced did not appear to have a dramatic impact. We find that changes in financial incentives on both the supply-side (such as reimbursement increases) and the demand-side (i.e., benefit changes) alone may not be enough to generate the desired levels of preventive care, especially among those with chronic health conditions.
    Medicare & medicaid research review. 01/2012; 2(4).
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Emergency department (ED) use for nonemergent conditions is associated with discontinuity of care at a greater cost. The objective of this study was to determine whether the quality of patient-provider communication and access to one's usual source of care (USC) were associated with greater nonemergent ED use. A hurdle model was employed using data from the 2007 to 2009 Medical Expenditure Panel Survey. First, a multivariate logistic regression model was used to identify factors associated with the likelihood of a nonemergent ED visit. Given that one occurrence exists, a second negative binomial model was used to establish whether patient-provider communication or access are related to the frequency of nonemergent ED use. One element of communication, patient-provider language concordance, is associated with fewer nonemergent ED visits (P < .05). Several aspects of access are related to reduced ED use for nonemergent purposes. Patients whose USC is available after hours and those who travel less than an hour to get to their USC use the ED less for nonemergent care (P ≤ .05). Enhancing primary care by expanding interpreter services and access to care after hours may reduce the demand for nonemergent ED services.
    The Journal of the American Board of Family Medicine 11/2013; 26(6):680-91. · 1.85 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the relationship between the provision of episodic medical care at the worksite and nonadmission emergency department (ED) visits. A historical cohort design was used to study the differences of nonadmission ED visits among insurance plan participants employed at two acute care hospitals, one with a worksite wellness clinic and one without over an 8-year period. A significant reduction in the risk of an insurance plan member visiting the ED in the time period after the clinic was opened among plan members with access to a worksite wellness clinic was observed. No significant reduction was noted in ED visits for insurance plan members without access to a worksite clinic. A wellness clinic rendering episodic medical care is associated with significant reductions in ED visits and insured employees who use an ED.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 12/2014; 56(12):1313-1318. · 1.88 Impact Factor

Full-text

Download
11 Downloads
Available from
May 16, 2014