Emergency Department Use and the Affordable Care Act: The Effect of the Affordable Care Act on Frequent Emergency Department Users
Abstract
Emergency departments (EDs) are an essential component of the US healthcare system. Beyond treating patients in urgent need, they also serve as safety nets for those who lack healthcare access alternatives. Due to the high cost and the limited continuity of care associated with the use of the EDs, one of the main goals of the Affordable Care Act (ACA) was to reduce the use of ED services. This dissertation addresses gaps in the literature and extends the existing findings on both ED use and on frequent ED (FED) use in the post-ACA period.
The first paper updates the current literature and systematically reviews and synthesizes the patient characteristics and contextual factors that are more prevalent among FED patients compared to non-frequent users after 2010. This study finds that FED patients are predominantly publicly insured and exhibit higher prevalence of chronic conditions, particularly mental health and substance use disorders.
The second study of this dissertation examines the effect of the Medicaid expansion under the ACA on total and per 1,000 residents' ED utilization in New York from 2011 to 2016 using interrupted time-series models. The findings indicate increases in overall average monthly ED visits (+3%), and in Medicaid covered ED visits (+23%) while ED visits declined for the uninsured (-28%) and for the privately insured (-5%) in the post-ACA period. After adjusting for changes in insurance-mix, ED visits rates per 1,000 residents increased for Medicaid (+0.3%) and for those remaining uninsured (+10%), while private insurance visits rates decreased (-8%). Primary-care treatable ED visits and visits related to mental health and alcohol disorders, substance use, also increased after the ACA implementation.
The third paper estimates the effect of the Medicaid expansion policy implementation under the ACA on the likelihood of being a FED patient using multivariate logistic and negative binomial regressions, and data for New York from 2011 to 2016. The results indicate that the likelihood of FED use declined among Medicaid beneficiaries and the uninsured, while the opposite occurred for those enrolled in private plans.
Citation
Giannouchos, Theodoros (2020). Emergency Department Use and the Affordable Care Act: The Effect of the Affordable Care Act on Frequent Emergency Department Users. Doctoral dissertation, Texas A&M University. Available electronically from https : / /hdl .handle .net /1969 .1 /191642.