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Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act.
Ann Emerg Med. 2017 Feb; 69(2):172-180.AE

Abstract

STUDY OBJECTIVE

We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state.

METHODS

Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer. Visit data were combined with 2010 to 2014 census insurance estimates to compute payer-specific ED visit rates. Interrupted time-series analyses tested changes in ED visit rates and ED hospitalization rates by insurance type after ACA implementation.

RESULTS

Average monthly ED visit volume increased by 14,080 visits (95% confidence interval [CI] 4,670 to 23,489), a 5.7% increase, after ACA implementation. Changes by payer were as follows: uninsured decreased by 24,158 (95% CI -27,037 to -21,279), Medicaid increased by 28,746 (95% CI 23,945 to 33,546), and private insurance increased by 9,966 (95% 6,241 to 13,690). The total monthly ED visit rate increased by 1.8 visits per 1,000 residents (95% CI 0.6 to 3.0). The monthly ED visit rate decreased by 8.7 visit per 1,000 uninsured residents (95% CI -11.1 to -6.3) and increased by 10.2 visit per 1,000 Medicaid beneficiaries (95% CI 4.4 to 16.1) and 1.3 visits per 1,000 privately insured residents (95% CI 0.6 to 1.9). After adjusting for baseline trends and season, these changes remained statistically significant. The total number of hospitalizations through the ED was unchanged.

CONCLUSION

ED visits by adults aged 18 to 64 years in Illinois increased after ACA health insurance expansion. The increase in total ED visits was driven by an increase in visits resulting in discharge from the ED. A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in ED visits by uninsured patients. These changes are larger than can be explained by population changes alone and are significantly different from trends in ED use before ACA implementation.

Authors+Show Affiliations

Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: s-dresden@northwestern.edu.Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL.Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL.Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL.Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27569108

Citation

Dresden, Scott M., et al. "Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act." Annals of Emergency Medicine, vol. 69, no. 2, 2017, pp. 172-180.
Dresden SM, Powell ES, Kang R, et al. Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act. Ann Emerg Med. 2017;69(2):172-180.
Dresden, S. M., Powell, E. S., Kang, R., McHugh, M., Cooper, A. J., & Feinglass, J. (2017). Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act. Annals of Emergency Medicine, 69(2), 172-180. https://doi.org/10.1016/j.annemergmed.2016.06.026
Dresden SM, et al. Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act. Ann Emerg Med. 2017;69(2):172-180. PubMed PMID: 27569108.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act. AU - Dresden,Scott M, AU - Powell,Emilie S, AU - Kang,Raymond, AU - McHugh,Megan, AU - Cooper,Andrew J, AU - Feinglass,Joe, Y1 - 2016/08/25/ PY - 2016/02/29/received PY - 2016/06/14/revised PY - 2016/06/16/accepted PY - 2016/8/30/pubmed PY - 2017/6/21/medline PY - 2016/8/30/entrez SP - 172 EP - 180 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 69 IS - 2 N2 - STUDY OBJECTIVE: We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state. METHODS: Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer. Visit data were combined with 2010 to 2014 census insurance estimates to compute payer-specific ED visit rates. Interrupted time-series analyses tested changes in ED visit rates and ED hospitalization rates by insurance type after ACA implementation. RESULTS: Average monthly ED visit volume increased by 14,080 visits (95% confidence interval [CI] 4,670 to 23,489), a 5.7% increase, after ACA implementation. Changes by payer were as follows: uninsured decreased by 24,158 (95% CI -27,037 to -21,279), Medicaid increased by 28,746 (95% CI 23,945 to 33,546), and private insurance increased by 9,966 (95% 6,241 to 13,690). The total monthly ED visit rate increased by 1.8 visits per 1,000 residents (95% CI 0.6 to 3.0). The monthly ED visit rate decreased by 8.7 visit per 1,000 uninsured residents (95% CI -11.1 to -6.3) and increased by 10.2 visit per 1,000 Medicaid beneficiaries (95% CI 4.4 to 16.1) and 1.3 visits per 1,000 privately insured residents (95% CI 0.6 to 1.9). After adjusting for baseline trends and season, these changes remained statistically significant. The total number of hospitalizations through the ED was unchanged. CONCLUSION: ED visits by adults aged 18 to 64 years in Illinois increased after ACA health insurance expansion. The increase in total ED visits was driven by an increase in visits resulting in discharge from the ED. A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in ED visits by uninsured patients. These changes are larger than can be explained by population changes alone and are significantly different from trends in ED use before ACA implementation. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/27569108/Increased_Emergency_Department_Use_in_Illinois_After_Implementation_of_the_Patient_Protection_and_Affordable_Care_Act_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(16)30304-3 DB - PRIME DP - Unbound Medicine ER -