Study: Medicaid patients use emergency room more, not less

posted at 7:01 pm on January 2, 2014 by Mary Katharine Ham

Another Obamacare rationale bites the dust:

A new study of Medicaid beneficiaries in Oregon makes a strong version of this case. The study, published today in the journal Science, finds that adult Medicaid beneficiaries rely on emergency rooms about 40 percent more than similar uninsured adults.

“When you cover the uninsured, emergency room use goes up by a large magnitude,” said Amy Finkelstein, a health economist at the Massachusetts Institute of Technology who served as a lead investigator on the study, in an MIT press statement accompanying the study.

There were no exceptions to the trend. “In no case were we able to find any subpopulations, or type of conditions, for which Medicaid caused a significant decrease in emergency department use,” said Finkelstein.

We’ve seen real-world evidence that Medicaid increases emergency room utilization before, in states like California. But the Oregon study should settle any lingering debate.

These results, reported by Peter Suderman at Reason, were reported in the journal Science and are based on the Medicaid study in Oregon that made news in May for showing Medicaid patients had no material health improvements over the uninsured.

The Oregon study is important because it’s a randomized controlled trial— the research gold standard we’ve reported on before in studies like the Tennessee Pre-K study and the Washington, D.C. Opportunity Scholarship study. Washington state held a lottery for access to Medicaid and then studied the both the cohort that got Medicaid and the cohort that did not. This means the cohorts were randomly selected within a group of people with similar motivations, economic situations, etc., making them more accurately comparable.

Suderman notes that Medicaid recipients are less likely to experience ” feel better after they are covered, and they are much less likely to be subject to large, health-related financial shocks,” making it largely a “financial buffer” instead of a health program. If our friends on the Left were as pro-science as they purport to be, they’d acknowledge it’s worth discussing whether we’re accomplishing what we want to accomplish with these very expensive programs. Research shows we’re not helping people as advertised. If we’d like to actually help people instead of just patting ourselves on the back for saying we’re helping them, we’ve got to rethink these programs instead of expanding them. If anything, the Oregon study offers a pretty decent argument for Republican governors that skipping Medicaid expansion wasn’t just the right fiscal decision, but the right one for general health outcomes and emergency room crowding.

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One liberal argument, that my brother in law uses too, is that we now pay for the uninsured already, since they use the emergency rooms. The suggestion is the ObamaCare would cure that. I’m glad to see this issue addressed in a sensible and measured way here.

Paul-Cincy on January 2, 2014 at 7:11 PM

Of course they do… The Medicaid people are mostly from the welfare class and they think that they are entitled for everything and someone else is obliged to pay for it…

mnjg on January 2, 2014 at 7:13 PM

No kidding. People who have no compunction against taking stuff for free will take more of it

Lanceman on January 2, 2014 at 7:14 PM

To give a little taste of what’s in our future, here’s a feature article from a Calgary Alberta newspaper about an orthopedic surgeon who is taking the bold move of opting out of the public system. He’s 65, the past president of the Alberta Medical Association. and former clinical chief of orthopedics in Calgary, and he says access has worsened since he started his career in 1979.

Frustrated with wait times, Calgary doctor quits public health system

Surgeon frustrated over long waits for care

Frustrated watching patients wait too long for medical care, a prominent Calgary orthopedic surgeon is taking the unusual step of opting out of the public health-care system – a move that will allow him to charge patients for privately delivered procedures.

Dr. Robert Hollinshead is set to become the only Alberta doctor providing patients medically necessary care not paid for by the Alberta Health Care Insurance Plan.

The physician said too many young surgeons can’t find work in the province, meanwhile, patients are waiting months and years too long for hip, knee and other surgeries because the government isn’t properly funding the public system. “I feel that governments do not have the stomach to put the kind of money into the system that would help it go from long, long waiting lists to timely access,” Hollinshead said in an interview on Thursday.

Drained Brain on January 2, 2014 at 7:15 PM

If anything, the Oregon study offers a pretty decent argument for Republican governors that skipping Medicaid expansion wasn’t just the right fiscal decision, but the right one for general health outcomes and emergency room crowding.

I think that the wisdom of opting out of Medicaid expansion will show itself in a few years when the federal bribes for expansion dry up.

Happy Nomad on January 2, 2014 at 7:15 PM

One liberal argument, that my brother in law uses too, is that we now pay for the uninsured already, since they use the emergency rooms. The suggestion is the ObamaCare would cure that. I’m glad to see this issue addressed in a sensible and measured way here.

Paul-Cincy on January 2, 2014 at 7:11 PM

What is your white liberal brother in law daily interaction with the welfare class and its behavior? Very little to none of course… I am sure like every white liberal hypocrite he avoids them like avoiding like a plague but he talks all the time about how we should pay to help them…

mnjg on January 2, 2014 at 7:16 PM

You will never change the nature of man and for the life of me don’t understand why either party tries with regards to certain issues..

theblacksheepwasright on January 2, 2014 at 7:17 PM

You will never change the nature of man and for the life of me don’t understand why either party tries with regards to certain issues..

theblacksheepwasright on January 2, 2014 at 7:17 PM

Going against human nature is a sure failure… In this case the human nature of the welfare class is to take more and more from the tax payers…

mnjg on January 2, 2014 at 7:19 PM

What is your white liberal brother in law daily interaction with the welfare class and its behavior? Very little to none of course… I am sure like every white liberal hypocrite he avoids them like avoiding like a plague but he talks all the time about how we should pay to help them…

mnjg on January 2, 2014 at 7:16 PM

I think they feel guilty but don’t want to get their hands dirty, so the government is their “go between”..

theblacksheepwasright on January 2, 2014 at 7:26 PM

Does anyone believe anything the federal government says any more?

bw222 on January 2, 2014 at 7:34 PM

I think they feel guilty but don’t want to get their hands dirty, so the government is their “go between”..

theblacksheepwasright on January 2, 2014 at 7:26 PM

I think that liberals are mentally ill… No one can be such a hypocrite like your typical liberal and not has something wrong with the mind… They simply cannot see or acknowledge their hypocrisy on so many issues they preach…

mnjg on January 2, 2014 at 7:44 PM

http://www.live5news.com/story/22075845/live-5-news-investigates-woman-accused-of-using-ambulance-for-taxi-service

The Dorchester County Sheriff’s Office says 51-year-old Audrey Ferguson of the Dorchester community has called EMS at least 100 times in the last seven years.

Investigators say Ferguson was faking illness, just to get a free ride to downtown Charleston.

According to the incident report, Ferguson said she didn’t have a car and this was the only way she had to get around and Medicaid paid for it anyway. It was part of her benefits.

And all of those ambulance trips taken by Ferguson?

Each one costs $425, plus mileage. Officials say what Medicaid doesn’t pay, taxpayers will have foot the rest of the bill, more than $400,000.

This of course ignores the fact that taxpayers are ALSO paying what Medicaid DOES pay of course.

SoRight on January 2, 2014 at 7:44 PM

U N I N T E N D E D Consequences.
Who’da thunk it?

Missilengr on January 2, 2014 at 7:50 PM

Embrace The Suck™

Electrongod on January 2, 2014 at 7:53 PM

Remember back when someone said something about ‘liberals claim to know a lot. But a lot of what they ‘know’ simply isn’t true.’

GarandFan on January 2, 2014 at 8:03 PM

Anecdotal story.

Three months ago, a neighbor who likely is or will be a Medicaid beneficiary hurt himself on a Friday night at a bar. At noon the following day, rather than have a friend take him to the hospital, a fire truck and EMS unit showed up to take him to the hospital for a broken ankle requiring pins.

Waste of resources.

BuckeyeSam on January 2, 2014 at 8:07 PM

That which you subsidize you get more of.

If these leaches were required to pay for the ambulance and the ER, they would quickly stop bothering those who are charged with saving lives instead of coddling life’s losers.

turfmann on January 2, 2014 at 8:08 PM

Anecdotal story.

Three months ago, a neighbor who likely is or will be a Medicaid beneficiary hurt himself on a Friday night at a bar. At noon the following day, rather than have a friend take him to the hospital, a fire truck and EMS unit showed up to take him to the hospital for a broken ankle requiring pins.

Waste of resources.

BuckeyeSam on January 2, 2014 at 8:07 PM

At one point in my career I was working for an organization providing managed care to SSI-eligible children in DC. It was routine that mom would call the ambulance to get to scheduled doctor’s appointments. And Medicaid paid! Pure lunacy.

Happy Nomad on January 2, 2014 at 8:11 PM

Waste of resources.

BuckeyeSam on January 2, 2014 at 8:07 PM

Take a listen to your local fire department scanner on any given night. 50% plus of the calls to EMS are nothing more serious than what you do to yourself with a razor each morning.

I was listening to the locals just now and there was a team of firefighters/EMT’s yelling into the radio for the PD to step it up big time as the call they were on wasn’t a call for medical assistance but rather a very violent domestic dispute.

Hearing your neighbors scream “EXPEDITE” into the radio is no way to start the new year.

turfmann on January 2, 2014 at 8:12 PM

I love that there is an ambulance in the picture.

Realize this:

If you have no insurance an ambulance ride is so expensive that there are actually ambulance-only insurance plans that are cheap that you can join “just in case”.

If you have insurance, the co-pay for an ambulance is very expensive ONCE they have agreed you actually need one.

If you have Medicaid, you can call one every time you have a contraction to go to L&D and be sent home. One lady laughingly showed up by ambulance 5 times in 7 nights, and the hospital actually gave her a cab voucher to go home each time and was thinking of giving her a cab voucher to come in, because it is probably 1/100th the expense of an ambulance ride. They don’t care. Obama-stash covers it.

Marcus on January 2, 2014 at 8:15 PM

This must be “Captain Obvious releases the results of all the studies” day.

As in the conceal carry thread – um… ‘duh’.

Midas on January 2, 2014 at 8:16 PM

Suderman notes that Medicaid recipients are less likely to experience ” feel better after they are covered, and they are much less likely to be subject to large, health-related financial shocks,” making it largely a “financial buffer” instead of a health program. If our friends on the Left were as pro-science as they purport to be, they’d acknowledge it’s worth discussing whether we’re accomplishing what we want to accomplish with these very expensive programs.

By the way, MKH – is this your early entry in the ‘best run-on sentence for 2014′ contest?

Midas on January 2, 2014 at 8:18 PM

Crap, copied too much stuff. My main point was that the first sentence looks disjointed a bit, hehe.

I’ll shut up now.

Actually, no, I probably won’t.

Midas on January 2, 2014 at 8:19 PM

I had a patient who pretty much hit one of the three city ERs every day for the hot food. As he was well known, sometimes they would boot him quickly without much testing (he was diabetic and had heart disease). If he was still hungry he’d go to another ER. If he was dirty, he’d get a sponge bath for free also. Gotta love that Medicaid.

talkingpoints on January 2, 2014 at 8:35 PM

SoRight on January 2, 2014 at 7:44 PM

There has been at least one news report of people using ambulances as taxis in Montgomery County MD since the county started picking up all the ambulance bills.

Count to 10 on January 2, 2014 at 8:40 PM

Imagine if we had an economy that was actually recovering rather than one crippled by Obama’s fundamental transformation, redistribution, and chaos.

BuckeyeSam on January 2, 2014 at 8:47 PM

Tooth aches, menstrual cramps, minor lacerations, gold teeth displacement, menstrual issues, sniffles, slight coughs, pregnancy tests, foot pain, stiff ankles, subjective back pain or neck pain…

/ObamaCare.

Pay for it, biches!

Key West Reader on January 2, 2014 at 9:07 PM

Nothing should be free. This is what happens when you give crap away. Any and every plan, any procedure and process and visit including Medicaid should have a copay.

slickwillie2001 on January 2, 2014 at 10:04 PM

My brother was a city paramedic for several years. he said they call 911 to complain of “chest pains”, just to get a free ride to their Dr appt (at the hospital) or to pick up a prescription. They always have their public assistance card ready when the paramedics show up, they know the system. They do this because they don’t have a car & they don’t want to ride the bus. Pathetic

mdenis39 on January 2, 2014 at 10:27 PM

My friend who’s an EMT has told me the same thing that many have just said…people use the Ambulance for free rides into town or to the hospital to get their “needed” pain meds refilled. 75% of his calls are complete crap according to him and almost everyone is on state or federal assistance.

But remember what our liberal friends tell us, “Waste isn’t as common as people would have us believe and to try and end fraud is borderline criminal and racist!”

nextgen_repub on January 2, 2014 at 11:33 PM

Why wouldn’t they? Doesn’t cost nuthin’.

Ronnie on January 3, 2014 at 12:25 AM

The thing about the Oregon study is that it examined similar populations, just that one was covered by Medicaid and one was not. Who was in which pool was actually randomly arrived at because these were people who had the opportunity to get Medicaid coverage but there were so many compared to the available slots that the authorities held a lottery.

I would speculate that if you did not have coverage your mindset was to tough it out. Otherwise the first choice would have been to go to the Emergency Room where you would be treated and they would try to charge you (not that they would necessarily succeed in collecting).

People with Medicaid may have the mindset of “I am ill” and tried to find a doctor who would see them. Failing that, they “knowing” they are ill would then have an incentive to go to the Emergency Room for treatment.

The probable presumption behind a lower emergency room usage by Medicaid participants is that Medicaid would allow them to see a doctor in his office or clinic. The fact that reimbursements tend to be very low, hence the doctor tends to get less than it costs to deliver the service (at least in his eyes), so he has a real disincentive to see Medicaid patients, may be knowingly discounted because the proponents don’t want to admit that properly covering Medicaid patients would cost a whole lot more than advertised. Not good for the program.

Russ808 on January 3, 2014 at 12:35 AM

Why wouldn’t they? Doesn’t cost nuthin’.

Ronnie on January 3, 2014 at 12:25 AM

It’s a phenomenon known in economics as “moral hazard.” When you don’t have to pay for the consequences of risk, you are more likely to engage in risky behavior. Suffice it to say, moral hazard figures heavily in all kinds of insurance, particularly health and auto insurance.

gryphon202 on January 3, 2014 at 12:55 AM

A few thoughts.

I don’t think all of it can be attributed to waste. My parents have been ‘hosting’ a family of 7 for the past 4 years. The kids are on medicaid. The family can’t find a primary care physician. So, every time one of the kids is sick or injured (but not in an emergency situation), they have no option but to go to the ER. They do drive themselves in, rather than taking ambulances and they aren’t going in for every sniffle. It’s basically taking the place of my primary care physician (except that because I have a co-pay, I see my doctor a whole lot less frequently).

On the other hand, there was a woman in our old neighborhood (we called her the crying lady) that was constantly calling an ambulance because of her “seizures”. Everyone in the neighborhood knew that the truth was that her drug dealer lived three blocks from the hospital. She’d have a ‘miraculous recovery’ right when they arrived at the hospital and would hop out of the ambulance and walk down the street.

It would be interesting to know if there were more of the former (people that would use a PCP if one would accept medicaid) or the latter (people that waste it because it costs them nothing).

JadeNYU on January 3, 2014 at 2:47 AM

Another thing worth noting is that there were no health benefits for the people that could go to the ER (and did) vs the people that had to ‘tough it out’.

I’d be interested in knowing if it’s the same for the insured.

My hypothesis being that we run to the doctor for too many thing (such as colds and the flu) that they aren’t able to help with. It could make us feel better to have done something, but, it’s not going to make us any healthier (or sicker).

Of course, this has nothing to do with major illnesses where surgery, chemo, etc make a huge difference in outcomes for people who are treated vs. untreated.

JadeNYU on January 3, 2014 at 3:00 AM

Another thing worth noting is that there were no health benefits for the people that could go to the ER (and did) vs the people that had to ‘tough it out’.

I’d be interested in knowing if it’s the same for the insured.

My hypothesis being that we run to the doctor for too many thing (such as colds and the flu) that they aren’t able to help with. It could make us feel better to have done something, but, it’s not going to make us any healthier (or sicker).

Of course, this has nothing to do with major illnesses where surgery, chemo, etc make a huge difference in outcomes for people who are treated vs. untreated.

JadeNYU on January 3, 2014 at 3:00 AM

No offense Jade, but you’re overthinking it. The principles at work here aren’t terribly complex, even if there are a lot of numbers to comb through when it comes to specifics.

Insurers use statistics culled from actuarial tables to define who they can insure, how much it will cost them to be insured, and other statistical minutiae. The reason you’ve got all these freaky bonuses and discounts in auto insurance is because computers have made it much faster and easier to store and retrieve statistical information, but that is really neither here nor there. What is important to remember about actuarial tables is that the act of insuring people skews the statistics. It doesn’t matter what you’re insuring or who. It throws the statistics “off” somewhat to an unpredictable degree.

That’s actually how GEICO was founded. Government Employee Insurance COoperative. It’s always been a private company, but the founders determined that not only were government employees less risky overall to insure, but that they were also less prone to moral hazard.

This, then, is at the heart of virtually everything that’s been wrong in the health insurance industry since the end of WWII. As employees (many union) demanded more and more fringe benefits from their employers post-war (in the midst of a wage and price freeze in the war’s immediate aftermath), the moral hazard of practically universal health insurance increased. And of course that caused prices to rise. It always does. But it also provided the perfect political pretext for our betters in the Washington DC cesspool to “do something” to solve a non-existent problem, thereby making it worse. See how this works? It never fails.

gryphon202 on January 3, 2014 at 6:07 AM

Liberals would hate it, but the obvious answer has always been public hospitals and clinics, available to those who do not pay for their own health care. Yes, they might have longer waits for some procedures than those who go to the “paid for” hospital. And they might wait longer to see a doctor. But, hey, if they want the shorter waits, they can pay for it like the rest of us.

Of course we all know these would soon become horror stories because they’d be bureaucracies, just like the folks who gave us Healthcare.gov. But isn’t that more proving our point than a reason not to do it?

The biggest fallacy in Obamacare is that the freeloaders should have the same care/doctors/hospitals as those who pull the wagon. I say: Why? I’ve paid for myself all my life. And I’ve paid for many of them to be on Medicaid. But now they want me to pay more….while waiting in line behind them in my doctor’s waiting room. It’s a crock.

jeanneb on January 3, 2014 at 8:39 AM

They conducted a study to prove this very truth? I work in an ER and I see the inane reasons those with Medicaid and the uninsured go to an ER. Every little sniffle, sore throat, dental pain, cough, and sneeze they run to the ER, clog our system and utilize expensive services. And they get angry when they are triaged and have to wait. Imagine that! There isno expectation for payment and yes they get the same treatment a fully insured patient receives. I believe this issue has as much to due with life styles, choices, and lack of responsibility than anything else. But no politician has the guts to say it.

stop2think on January 3, 2014 at 8:40 AM

Want to solve this problem? Start charging Medicaid patients a very minimal co-pay. Just $5-$10 a visit is all it would take.

iceman1960 on January 3, 2014 at 9:15 AM

Of course they do. What doc in their right mind would take on Medicaid patients?

ctmom on January 3, 2014 at 11:15 AM

Why can’t ER’s turn people away now that Obamacare has taken care of the no insurance problem?

ctmom on January 3, 2014 at 11:17 AM

This was predicted:

http://mercatus.org/sites/default/files/Blahous_MedicaidExpansion_v1.pdf

Money quote (p. 27);

Thus, taking important relevant factors into account, including both the higher
amount of health services received by the uninsured and the woodwork effect of
newly covering those previously eligible, it appears likely that expanding Medicaid
coverage would add substantially to state budget costs
. Again, the increase in state
costs does not mean that expansion’s potential cost savings to beneficiaries and
hospitals should be ignored, nor does it prove that a coverage expansion should not
be undertaken. It rather means that the likely costs of the expansion to states must
be weighed against any positive value associated with bringing more individuals
into Medicaid.

Chuckles3 on January 3, 2014 at 12:25 PM

In defense of Medicaid patients continuing to use ER’s vice doctors – how many here have ever tried to find a doctor who will accept a Medicaid patient? Many Medicaid patients end up using clinics which often have limited available office hours

katiejane on January 3, 2014 at 12:39 PM

katiejane on January 3, 2014 at 12:39 PM

That’s definitely true. The family that lives with my parents has no shot of finding a doctor that will take them on.

That said, if one of the stated goals of medicaid expansion is to get people out of the ERs, Medicaid will have to be set up in a way that doctors will accept it.

JadeNYU on January 3, 2014 at 1:56 PM

It would be interesting to know if there were more of the former (people that would use a PCP if one would accept medicaid) or the latter (people that waste it because it costs them nothing).

JadeNYU on January 3, 2014 at 2:47 AM

First, I know Primary Care Physicians (PCP)s really don’t want to take on Medicare for the simple reason that it pays exactly “crap”. The second part, in SOME cases, the patients are over-baring, needy and thank-less. They come in and have a list of ailments that takes a lot of time to address, when doctors usually set times by 15-20 min a visit.

Plus, if a doctor were to have only Medicare patients, I can easily say they will go out of business. From what I understand, 20 cents on the dollar is the return. Kinda like the Catholic Hospitals are doing currently. Doctors can absorb the costs to a point, then they need insured patients to “cover the cost”. Hence the term comes into play; “Nothing is free”.

-west

mr_west on January 3, 2014 at 3:33 PM

Want to solve this problem? Start charging Medicaid patients a very minimal co-pay. Just $5-$10 a visit is all it would take.

iceman1960 on January 3, 2014 at 9:15 AM

Ice,
Let me set the record straight on that… it’s ONLY $2-5 and that’s very close to costs of some prescriptions as well! Some of the patients say they can’t even cover that.

At least that is the cost in CO.

-west

mr_west on January 3, 2014 at 3:43 PM

More ER use by Medicaid? Well, DUH. Why do you think ER charges are so high? It’s passed along to the privately insured to cover time lost for care and malpractice costs for Medicaid patients (who, BTW, are the most litigious and demanding).

NoPain on January 4, 2014 at 2:23 PM