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Reform Update: Poor access to primary care, anxiety play big role in ED use, study finds


By Melanie Evans and Paul Demko
Posted: December 30, 2013 - 1:30 pm ET
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Experts hope that the healthcare reform law's insurance expansion in 2014 will reduce the need for Americans to visit the emergency department to get care. But a new survey suggests that anxiety and poor access to primary care—not just lack of insurance—play a substantial role in driving patients to the ED, calling into question the degree to which expanded coverage will reduce ED use.

The Center for Studying Health System Change found that insured adults with access to primary and urgent care said fear, not convenience, was far more likely to send them to the emergency room. Adults with trouble reaching a primary-care doctor were more likely to turn up in the emergency department, the survey found (PDF).

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“Patients' perception of the severity of their medical problem and who they first contact for help or advice are the factors most associated with whether they seek emergency care,” the Center for Studying Health System Change report said.

About 30% of those surveyed who visited an emergency room said the only reason they did so was a belief that they urgently needed care. Only about 2.5% said their trip to the ER was solely for convenience.

Notably, the adults surveyed had insurance with benefits that were designed to discourage unnecessary emergency room use, with higher out-of-pocket costs for the emergency room than primary and urgent care.

The National Institute for Health Care Reform, a not-for-profit established by the auto industry and organized labor, funded the survey of autoworkers and industry retirees. The survey, conducted by Mathematica Policy Research, asked respondents about their use of the emergency department in the last half of 2012 and first two months of this year. Mathematica surveyed 8,636 non-elderly adults. The response rate was 64.2%.

Half of those surveyed who reported an urgent medical need in the prior three months said they first contacted a primary-care physician for advice. Of those, nearly 60% were treated outside the emergency room by a doctor or nurse, and 11% were cared for over the phone. Doctors sent slightly more than 1 out of 10 (12%) to the emergency room.

Respondents who sought care in the ED were less likely to report access to routine primary-care appointments “as soon as needed” or that doctors spent enough time with them.

Alabama insurer includes cost of ACA in premiums

Insurers have long suggested that taxes that are part of the federal healthcare reform law will simply be passed on to consumers. But at least one health plan—Blue Cross and Blue Shield of Alabama—is annotating exactly how much of a premium can be attributed to the ACA. On one bill reviewed by Kaiser Health News, that portion was $23.14 per month.

Questions raised about contractor hired to fix Maryland's exchange site

Maryland has brought on Optum/QSSI to oversee fixes to its troubled exchange website. As the Baltimore Sun points out, Optum/QSSI has a strong interest in the success of the site. Its parent company, UnitedHealth Group, also owns one of the four insurance companies selling products on the exchange. State officials denied that there is any conflict of interest in the arrangement.

Follow Paul Demko on Twitter: @MHpdemko

Follow Melanie Evans on Twitter: @MHmevans


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