Tuesday, July 6, 2010

ER visits up... MA reform a bust?

During the push to enact universal health care coverage in Massachusetts during the 2005 to 2006 period, proponents argued that improved coverage would equate to a declining strain on the Commonwealth's emergency departments as un/underinsureds would have better access to primary and speciality care and, therefore, would need to avail themselves of ERs far less often.  It was a good argument, but early returns suggest that it may not have been correct.

On the 4th of July, the Boston Globe reported that ER visits have gone up, not down.  See the article here.  Citing Massachusetts Division of Health Care Finance and Policy figures, the article noted that visits are up 9 percent from 2004 to 2008 or approximately 3 million visits per year.  It's worth noting, as do those quoted in the piece, that this trend mirrors national numbers and that it probably has more to do with primary care shortages than anything else.  The newly insured may have coverage, but if they can't find a doctor...

My sense is that some may point to this information and claim that the Massachusetts universal health initiative has been a bust.  I argue that that would be unfounded or, more likely, irrelevant for the following reasons:
  • The primary care shortage is getting worse.  And even if you have a primary care physician, the wait for a sick visit (or even a routine physical) can be extremely long.  Additionally, the days of developing a unique and personal relationship with one primary primary care doctor may be over, as obtaining appointments with other physicians or nurse practitioners is now the norm.  It's a well documented phenomenon nationally that primary care numbers are down and that ER visits are up as a result.
  • Providing primary care and coordinated speciality services to many individuals who have not received such care historically may result in reduced ER visits by that population, but it will take longer than four years to prove the point.  Controlling my blood pressure today could prevent an MI in 10 or 15 years... probably not right away.
  • It's politically irrelevant.  It's seems very highly unlikely that a universal health coverage reversal initiative could gain any real traction.  Imagine being that candidate pushing that agenda.
The solution to the growing ER utilization problem (the waits are getting longer and the costs are escalating upward) lies in addressing the fundamental underlying issue... not in concluding that universal coverage is a flop.

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