Third, although high ED use has often been viewed as a proxy for a lack of access to primary care, most studies have not been able to assess the impacts of different care by different primary care providers (PCPs). Second, although some studies have used survey data to explain the Medicaid–commercial difference in ED use, there have been fewer efforts to assess the extent to which ED use could be explained by Medicaid–commercial differences in observable factors such as patient demographics, comorbidities, neighborhoods, and proximities to services to explain differences. First, although high ED use is a visible target for policy makers, less is known about whether the Medicaid–commercial utilization difference is unique to the ED or if it persists across other types of health services. There are several gaps in the knowledge of ED use among Medicaid beneficiaries. 6, 8, 9 Medicaid enrollees also might use the ED more frequently because they typically make minimal co-payments for ED visits, 1 or because they perceive the ED as a one-stop shop that provides multiple services simultaneously, an attribute appealing for patients who struggle with transportation. Medicaid enrollees have a higher comorbidity burden 1, 6, 7 and are more likely to experience primary care access problems or unsatisfactory primary care. 5 However, those policies may have limited effectiveness if they are based on incorrect assumptions about the underlying reasons for high rates of ED use in the Medicaid population.Ī variety of factors may explain differences in ED use among Medicaid and commercial patients. 1–4 State Medicaid programs have proposed different policies to reduce ED visits including requiring Medicaid patients to make higher co-payments for their ED visits or providing Medicaid patients with robust alternative services to ED care through patient-centered medical home models. T he high rate of emergency department (ED) use by Medicaid enrollees has been a long-standing concern among policy makers. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid–commercial difference in ED use, suggesting that the quality of primary care may influence ED use. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid–commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011–2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid–commercial differences in ED use can be explained by observable factors in administrative data. You may need to call 9-1-1 if the person’s condition needs immediate attention where you are.The high rate of emergency department (ED) use by Medicaid patients is not fully understood. Always get immediate medical attention if you think you or a loved one is having a medical emergency. Difficulty seeing, speaking, moving or breathingĬalifornia Health & Wellness supports each member and family member in their decision for medical care.Go to an Emergency Room (E.R.) or call 911 if you have any of these sudden, life-threatening symptoms: if you have these non-life-threatening symptoms: You may also call our 24/7 Nurse Line – for assistance at 1-87Ĭall your doctor, local clinic or urgent care facilityĪvoid the wait in the E.R. Or visit a local clinic or urgent care facility. For non-emergencies, please contact your primary care provider (PCP). You may need to call 9-1-1 if the person’s condition needs immediate attention where you are. If you think that you or a family member is having a medical emergency, go to the ER to see a doctor right away. How do you determine if or when you or a loved one should go to the ER? Many times the condition may require a visit to an emergency room (ER). California Health & Wellness understands that you may have health conditions that need immediate attention.
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