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ER use by newly insured drops after three years of coverage

January 29, 2014

  • UCLA Center for Health Policy Research

    An experimental program to provide a "medical home" to uninsured, low-income Californians resulted in a significant drop in costly emergency room (ER) care - but with a catch, according to a new comprehensive Center report.
     
    The study of California's Health Care Coverage Initiative (HCCI), an early "bridge" program to health care reform that provided health care coverage to 236,541 low-income Californians between 2007 and 2010, also found that the program increased access, quality of care and safety-net infrastructure.

    The ER "catch"? The lead author of the report, Nadereh Pourat, the Center's director of research, and her co-authors found that despite having access to primary care doctors, ER visits by HCCI enrollees increased slightly during the program.
     
    "It takes time for the long-term uninsured individuals to learn the ropes and understand that they now have a doctor they could go to who could help them stay away from ERs and hospitals," said Pourat. Many ER visits are unavoidable and other obstacles may have driven HCCI patients to the ER.
     
    By the end of the program, however, ER visits and hospitalizations declined and primary care visits increased significantly.
     
    "What became clear is that providing primary care, particularly to patients with chronic conditions, eventually pays off," said Pourat.
     
    The results have implications for Medicaid programs and Exchanges nationwide, programs and health plans that provide coverage and care to newly insured populations.

    The lesson, Pourat noted, is that "preventive and primary care can reduce demand for high-costs services. But it takes time and effort to change mindsets and behavior."