One of the key goals of health reform here in Massachusetts was to improve people’s health through prevention and primary care to the point that costly trips to the emergency room would decline. Until now, that hasn’t happened, according to several earlier reports.
But a just-released analysis, by the Blue Cross Blue Shield of Massachusetts Foundation found, for the first time, that ER visits (among non-elderly adults) have started to drop. Here, according to the report, which is also published in the current issue of the journal Health Affairs are the numbers:
Between fall 2006 and fall 2010, there were reductions in emergency department use overall (down 3.8 percentage points), frequent emergency department visits (down 1.9 percentage points), and the use of the emergency department for non-emergency conditions (down 3.8 percentage points). This is the first reduction in emergency department use among nonelderly adults in Massachusetts observed in the MHRS.
The reduced reliance on the emergency department among nonelderly adults may reflect many factors, including the increases in use of other types of health care (e.g., increases in preventive care visits, multiple doctor visits, specialist visits, and dental care) or increases in cost sharing under their health plans.
I asked John McDonough, Professor of Public Health Practice & Director of the Center for Public Health Leadership at the Harvard School of Public Health for his thoughts on the apparent drop in emergency department visits. Here’s his email response:
First, on the face of it, it’s good news to see ED use going down after so many years of no changes, and especially because that was an outcome many expected out of MA health reform. We expected this to happen, and when it did not, many were puzzled, and many used the non-drop as evidence of health reform’s failure.
Second, given the time lag, it’s not clear this most recent drop is because of MA health reform or because of other factors. I don’t know of any specific policy changes that might account for this drop at this point in time — so one would have to view a connection with some skepticism.
Third, there is a belief that cost sharing generally is going up, and that is leading folks to use fewer medical services; and the health plans in Massachusetts have confirmed that drop in usage. So it’s not that surprising to see it begin to show up in this indicator.
Finally, it seems we need more data and analysis to give us a better picture of what is really going on. Are people just not getting necessary care, or are they getting care in other places? Are people not getting medically necessary care, or are they more likely to not obtain unnecessary services? What groups in the population are dropping their use the most?
All these matter in reaching some more definitive conclusions.
I also asked health policy expert Nancy Turnbull, Associate Dean for Educational Programs at Harvard’s School of Public Health, for a quick reaction. She was even more upbeat than her colleague. She emails:
This is very good news and exactly one of the results that we hoped for from expanding health insurance: a reduction in the use of the ED for conditions that don’t need to be treated in the ED. Unnecessary use of the ED is expensive, both for individuals and the health care system, and it results in longer waits and a drain on resources that can be better used taking care of people who do need emergency care. The quality of care provided in the ED is also episodic so it’s not high quality care for people who have chronic conditions. Health insurance is a powerful means to help people get the care they need in the most appropriate setting, and this report confirms that’s happening as a result of the coverage expansions here. Great news here and a sign of what’s ahead nationally as the ACA is fully implemented.