Some low-income US patients may have an easier time choosing a hospital for emergency care thanks to the Patient Protection and Affordable Care Act (ACA), a new study suggests.

Under the ACA, also known as Obamacare, some US states expanded coverage through Medicaid – a joint federal and state insurance program for the poor – starting in 2014.

That year, average travel times to the hospital for emergency department (ED) care dropped 9 minutes in 17 states where Medicaid coverage expanded, while it remained little changed in 19 states that didn’t make more people eligible for these benefits, the study found.

The study only looked at for-profit hospitals. Previous research suggests that poor and uninsured patients sometimes travel longer distances in an emergency to avoid for-profit hospitals closer to home out of concern about the bills. Instead, they would seek treatment at nonprofit facilities that might offer free or discounted care, said senior study author John Graves of Vanderbilt University School of Medicine in Nashville, Tennessee.

“By focusing in particular on ‘non-discretionary’ conditions such as poisoning, femur fractures, etc. – that is, conditions for which the individual would very likely have been treated in an ED regardless of insurance status – we show that ED visits for these services increased at our study sample hospitals, which were drawn from private, for-profit hospital chains,” Graves said by email.

“This finding, coupled with our finding that Medicaid patients in expansion states travelled shorter distances, is evidence that people shifted where they sought ED care when they needed it,” Graves added.

For the current study, researchers examined data on more than 1 million emergency department visits for adults aged 18 to 64 on Medicaid in 2013 and 2014 at 126 investor-owned hospital emergency departments.

They used zip codes for the hospitals and patients’ homes to estimate average travel times and examined conditions that needed immediate treatment – the so-called non-discretionary care – as well as less critical issues that might be handled in an urgent care clinic or by a primary care provider.

Before 2014, the hospitals in the study had similar proportions of uninsured patients. By the end of that year, the proportion of uninsured patients seen by EDs in expansion states dropped 47 percent, researchers report in the Annals of Internal Medicine.

At the same time, the number of Medicaid visits in expansion states increased 126 percent by the end of 2014, compared with an 11 percent increase in states that didn’t expand coverage.

For non-discretionary care, in particular, the number of ED visits by uninsured patients dropped 42 percent in expansion states while Medicaid visits increased by 213 percent, the study found.

Average travel time from home to the hospital decreased by 6.2 percent among Medicaid patients in expansion states, while it remained unchanged in other states.

One limitation of the study is that it only looked at for-profit, investor-owned hospitals, which makes it hard to say how coverage changes may have played out at nonprofit or public hospitals, the authors note.

It’s also possible that the lower travel times for expansion states were mostly reduced by previously uninsured patients in cities who gained coverage that let them seek to care closer to home, rather than truly statewide reductions, said Dr. Mahshid Abir, a health policy researcher at the University of Michigan in Ann Arbor who wasn’t involved in the study.

The study also didn’t touch on another key issue related to time – how long people wait for care once they get to the hospital, Abir added by email.
Still, the reduced travel times may translate into better outcomes for patients, said Brendan Saloner, a public health researcher at Johns Hopkins University in Baltimore who wasn’t involved in the study.

“This is good news for patients when one considers that people who are uninsured often are required to go to a far away from the emergency room that will provide them with reduced cost care,” Saloner said by email. “Alleviating this burden is a big deal because minutes cut down travelling to the hospital can literally make the difference for whether a patient lives or dies.”

21 December 2016 | 5:24 am

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