5 ms·

Strangely, a study on whether providing expanded medicaid* would reduce emergency room visits seemed to suggest that it did not: > It was widely believed that

Strangely, a study on whether providing expanded medicaid* would reduce emergency room visits seemed to suggest that it did not: > It was widely believed that having insurance would encourage people to get routine medical care in doctors' offices or clinics, instead of waiting until they have more serious symptoms and have to head to the ER, where care is most expensive. > The study's first findings, published a few years ago, showed that Medicaid was beneficial in many ways. It improved people's financial security. They went to the doctor when they were sick. And having the insurance correlated with a drop in rates of depression. > But the study also found Medicaid enrollees increased their emergency room visits by 40 percent over the first 15 months. [0] http://www.npr.org/sections/health-shots/2016/10/19/498526110/emergency-room-use-stays-high-in-oregon-medicaid-study http://www.npr.org/sections/health-shots/2016/10/19/49852611... edit: fixed medicare / medicaid

ameister14 9y ago
Medicaid =/= Medicare; totally different population
- trendia 9y ago
  fixed
dv_dt 9y ago
It's odd that the rates of going to the ER are discussed, but not the content or cost of the care during the visits... particularly when the article discusses the speculation that the increased visits might be doctors referring patients to the ER to take care of some specific condition... and you would think that would be lower cost than catastrophic care later.
- AnthonyMouse 9y ago
  > and you would think that would be lower cost than catastrophic care later. That's the whole question. It's possible that people without insurance would have just never gone to the doctor and then died without ever being treated by anyone. Dying of some preventable condition is obviously worse for them, but it doesn't inherently result in more money being spent on healthcare.
  - dv_dt 9y ago
    And if you look at rates of visits, while ignoring cost/content of the visits it seems like you're missing a big part of the analysis. Sure, letting people suffer and die is cheaper on the medical systems books - but people dying earlier than they need to is a negative cost on our society and larger economys side ... let alone the ethical questions there.
    - AnthonyMouse 9y ago
      > And if you look at rates of visits, while ignoring cost/content of the visits it seems like you're missing a big part of the analysis. Not so much, because of the way emergency rooms work. What costs is the capacity, not what you use it for. You have to pay the going rate for a surgeon who can do open heart surgery, even if that doctor is only administering aspirin for a headache. That's why a $.25 band-aid costs $100 at an ER. > Sure, letting people suffer and die is cheaper on the medical systems books - but people dying earlier than they need to is a negative cost on our society and larger economys side ... let alone the ethical questions there. But the original problem was that people can't afford healthcare, either individually out of pocket or collectively as insurance premiums or taxes. If covering more people under government insurance doesn't reduce costs then it doesn't solve the problem -- people still won't be able to afford healthcare. It doesn't help anything to make it mandatory as taxes so that they end up not being able to afford rent or food instead of health insurance. We need to figure out how to actually reduce costs so that the amount of healthcare people need costs less than the amount of money they have, so that it's possible for people to get healthcare without going bankrupt. That probably means people paying for more things out of pocket, because out of pocket payments shouldn't have triple the expense due to insurance paperwork, and people only compare prices when it's their own money.
      - dv_dt 9y ago
        > But the original problem was that people can't afford healthcare, either individually out of pocket or collectively as insurance premiums or taxes. If covering more people under government insurance doesn't reduce costs then it doesn't solve the problem -- people still won't be able to afford healthcare. There is a wealth of data that shows that the problem with health costs is in fact solved by strong government involvement in health care in systems where people don't pay out of pocket at all ... ignoring that data is willful ignorance. http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/ http://www.pbs.org/newshour/rundown/health-costs-how-the-us-... Proposing alternatives government involvement are interesting, but not very constructive if we can't even get to the point of agreement of how well real world health systems perform in other nations vs the US.
HarryHirsch 9y ago
But the study also found Medicaid enrollees increased their emergency room visits by 40 percent over the first 15 months. Well, did they go there because they were actually ill? If so, the experiment did in fact improve public health.
- trendia 9y ago
  From another article on the same study (albeit earlier): > "Medicaid coverage increases emergency department use, both overall and for a broad range of types of visits, conditions, and subpopulations," says Amy Finkelstein, an economics professor at MIT and one of the authors of the study. > "Including visits for conditions that may be most readily treatable in primary care settings." [0] http://www.npr.org/sections/health-shots/2014/01/02/259128081/medicaid-expansion-boosted-emergency-room-visits-in-oregon http://www.npr.org/sections/health-shots/2014/01/02/25912808...
  - HarryHirsch 9y ago
    "Including visits for conditions that may be most readily treatable in primary care settings." That's just engrained practice. People used to go to the ER instead of a regular physician, now they continue what they always did. You ask yourself why the hospital doesn't set up a regular practice on the premises and has triage send patients there.
    - dv_dt 9y ago
      Is the ER a cost center or a profit center? Often times, I wonder if even the hospitals themselves know... More seriously, I suspect routing routine patients to lower-cost settings would put ERs more in the red under our current system.
    - vonmoltke 9y ago
      > You ask yourself why the hospital doesn't set up a regular practice on the premises and has triage send patients there. In Texas, they are legally prohibited from doing so. They would have to send you to a physically-separate location, even if said location was still in the hospital's parent network.

ameister14 9y ago

Medicaid =/= Medicare; totally different population

trendia 9y ago
fixed

dv_dt 9y ago

It's odd that the rates of going to the ER are discussed, but not the content or cost of the care during the visits... particularly when the article discusses the speculation that the increased visits might be doctors referring patients to the ER to take care of some specific condition... and you would think that would be lower cost than catastrophic care later.

AnthonyMouse 9y ago
> and you would think that would be lower cost than catastrophic care later. That's the whole question. It's possible that people without insurance would have just never gone to the doctor and then died without ever being treated by anyone. Dying of some preventable condition is obviously worse for them, but it doesn't inherently result in more money being spent on healthcare.
- dv_dt 9y ago
  And if you look at rates of visits, while ignoring cost/content of the visits it seems like you're missing a big part of the analysis. Sure, letting people suffer and die is cheaper on the medical systems books - but people dying earlier than they need to is a negative cost on our society and larger economys side ... let alone the ethical questions there.
  - AnthonyMouse 9y ago
    > And if you look at rates of visits, while ignoring cost/content of the visits it seems like you're missing a big part of the analysis. Not so much, because of the way emergency rooms work. What costs is the capacity, not what you use it for. You have to pay the going rate for a surgeon who can do open heart surgery, even if that doctor is only administering aspirin for a headache. That's why a $.25 band-aid costs $100 at an ER. > Sure, letting people suffer and die is cheaper on the medical systems books - but people dying earlier than they need to is a negative cost on our society and larger economys side ... let alone the ethical questions there. But the original problem was that people can't afford healthcare, either individually out of pocket or collectively as insurance premiums or taxes. If covering more people under government insurance doesn't reduce costs then it doesn't solve the problem -- people still won't be able to afford healthcare. It doesn't help anything to make it mandatory as taxes so that they end up not being able to afford rent or food instead of health insurance. We need to figure out how to actually reduce costs so that the amount of healthcare people need costs less than the amount of money they have, so that it's possible for people to get healthcare without going bankrupt. That probably means people paying for more things out of pocket, because out of pocket payments shouldn't have triple the expense due to insurance paperwork, and people only compare prices when it's their own money.
    - dv_dt 9y ago
      > But the original problem was that people can't afford healthcare, either individually out of pocket or collectively as insurance premiums or taxes. If covering more people under government insurance doesn't reduce costs then it doesn't solve the problem -- people still won't be able to afford healthcare. There is a wealth of data that shows that the problem with health costs is in fact solved by strong government involvement in health care in systems where people don't pay out of pocket at all ... ignoring that data is willful ignorance. http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/ http://www.pbs.org/newshour/rundown/health-costs-how-the-us-... Proposing alternatives government involvement are interesting, but not very constructive if we can't even get to the point of agreement of how well real world health systems perform in other nations vs the US.

HarryHirsch 9y ago

But the study also found Medicaid enrollees increased their emergency room visits by 40 percent over the first 15 months. Well, did they go there because they were actually ill? If so, the experiment did in fact improve public health.

trendia 9y ago
From another article on the same study (albeit earlier): > "Medicaid coverage increases emergency department use, both overall and for a broad range of types of visits, conditions, and subpopulations," says Amy Finkelstein, an economics professor at MIT and one of the authors of the study. > "Including visits for conditions that may be most readily treatable in primary care settings." [0] http://www.npr.org/sections/health-shots/2014/01/02/259128081/medicaid-expansion-boosted-emergency-room-visits-in-oregon http://www.npr.org/sections/health-shots/2014/01/02/25912808...
- HarryHirsch 9y ago
  "Including visits for conditions that may be most readily treatable in primary care settings." That's just engrained practice. People used to go to the ER instead of a regular physician, now they continue what they always did. You ask yourself why the hospital doesn't set up a regular practice on the premises and has triage send patients there.
  - dv_dt 9y ago
    Is the ER a cost center or a profit center? Often times, I wonder if even the hospitals themselves know... More seriously, I suspect routing routine patients to lower-cost settings would put ERs more in the red under our current system.
  - vonmoltke 9y ago
    > You ask yourself why the hospital doesn't set up a regular practice on the premises and has triage send patients there. In Texas, they are legally prohibited from doing so. They would have to send you to a physically-separate location, even if said location was still in the hospital's parent network.