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Why Medicaid Patients Use The Emergency Department For Primary Care

Mon, 01/06/2014 - 9:48am
Kevin Pho, M.D.

A study from Science found that those on Medicaid in Oregon made 40% more visits to the emergency department.

The Oregon Health Insurance Experiment included about 90,000 low-income people and assigned 30,000 of them to Medicaid by lottery. It’s essentially a naturally-occurring randomized controlled trial.

The result seems to have caught the public policy experts by off guard:

“I suspect that the finding will be surprising to many in the policy debate,” said Katherine Baicker, an economist at Harvard University’s School of Public Health and one of the authors of the study.

But ask any practicing physician, and most would say the result is of little surprise.

Why?

The promise of insurance doesn’t guarantee access to care. Especially with Medicaid. To save money, Medicaid continually pressures physician reimbursements down, and obstructs care with a number of bureaucratic hurdles that exceed most private insurers. Cumbersome pre-authorizations and overly restrictive drug formularies, for instance.

It’s no wonder why fewer primary care doctors and specialists accept Medicaid.

Another reason is one of convenience.  Adrianna McIntyre at The Incidental Economist points to a Health Affairs study that interviewed Medicaid recipients, asking them why they chose the emergency department.

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