Evidence of increased emergency room use under Obamacare

[Axulus]

It's time to drop the idea that fewer people will use the emergency room if everyone is insured (or we have a UHC system).

This evidence is consistent with the Oregon Medicaid health experiment (a much more robust study).

But according to a new poll of emergency healthcare professionals, that hasn't happened. In a survey conducted by the American College of Emergency Physicians (ACEP), more than of quarter of the 2,000-plus respondents said they had witnessed an increase in ER visitors in the last year.

Roughly 90 percent of the respondents said the severity of illness or injury among ER visitors has either increased or remained the same.

"The reliance on emergency care remains stronger than ever," Dr. Michael Gerardi, president of the ACEP, said in a press release.

http://www.upi.com/Health_News/2015...its-are-rising-under-Obamacare/2831430748684/

 

[Jimmy Higgins]

Isn't this an issue that can be addressed with a little education?

 

[Tom Sawyer]

Isn't this an issue that can be addressed with a little education?

Not if the GOP has anything to say about school funding levels, it isn't.

 

[arkirk]

Whether you are insured or not, when you call a doctor's office in California, the first thing you get in a recorded message that if you are having a medical emergency, call 911. If more people are calling doctors because they are now insured, more people are hearing this message. The more people who hear this message, the more people are apt to call 911. The reason being that primary care physicians are overloaded and they cannot respond to problems rapidly. A call to 911 for medical assistance lands you in an emergency room, not your physicians's office. This MAY BE a contributing factor. It lines up with the alleged shortage of primary care physicians.

 

[ronburgundy]

It's time to drop the idea that fewer people will use the emergency room if everyone is insured (or we have a UHC system).

This evidence is consistent with the Oregon Medicaid health experiment (a much more robust study).

But according to a new poll of emergency healthcare professionals, that hasn't happened. In a survey conducted by the American College of Emergency Physicians (ACEP), more than of quarter of the 2,000-plus respondents said they had witnessed an increase in ER visitors in the last year.

Roughly 90 percent of the respondents said the severity of illness or injury among ER visitors has either increased or remained the same.

"The reliance on emergency care remains stronger than ever," Dr. Michael Gerardi, president of the ACEP, said in a press release.

http://www.upi.com/Health_News/2015...its-are-rising-under-Obamacare/2831430748684/

So, it doesn't bother you that on a question where there are hospital records and reliable actual numbers that could have been used, this study instead used the purely subjective opinion survey of highly biased emergency room workers who want more funding and say in the same survey that they need it to handle increased patients? Not to mention the response rate was about 1% for most states, and complainers tend to be most likely to respond to such surveys.

Also, even if those subjective estimates are at all valid, 44% of the respondents said that the severity of cases was higher, while only 12% said it was lower.
IF the severity is higher, then that means people with less severe cases are in fact going to their primary care physician just just ACA predicted they would. The overall increase in numbers just means that more people have more severe ailments than last year year, which is hardly surprising since their are more people on the planet, plus severe ailments fluctuate from year to year. IOW, your research has massive validity issues, and even if valid is actually consistent with the non-straw man predictions of the ACA.

 

[Axulus]

Isn't this an issue that can be addressed with a little education?

That very well could be, but I would want to see something demonstrating the effect it has before drawing any conclusions.

 

[Axulus]

It's time to drop the idea that fewer people will use the emergency room if everyone is insured (or we have a UHC system).

This evidence is consistent with the Oregon Medicaid health experiment (a much more robust study).



http://www.upi.com/Health_News/2015...its-are-rising-under-Obamacare/2831430748684/

So, it doesn't bother you that on a question where there are hospital records and reliable actual numbers that could have been used, this study instead used the purely subjective opinion survey of highly biased emergency room workers who want more funding and say in the same survey that they need it to handle increased patients? Not to mention the response rate was about 1% for most states, and complainers tend to be most likely to respond to such surveys.

Also, even if those subjective estimates are at all valid, 44% of the respondents said that the severity of cases was higher, while only 12% said it was lower.
IF the severity is higher, then that means people with less severe cases are in fact going to their primary care physician just just ACA predicted they would. The overall increase in numbers just means that more people have more severe ailments than last year year, which is hardly surprising since their are more people on the planet, plus severe ailments fluctuate from year to year. IOW, your research has massive validity issues, and even if valid is actually consistent with the non-straw man predictions of the ACA.

Which is why I said the Oregon Medicaid health study was far more robust. This new evidence isn't all that good but still consistent with the far more robust Oregon study.

Furthermore, wasn't part of the selling point of Obamacare that more insured people would mean that there would be _fewer_ severe cases, as people with a potential health issue would see a doctor sooner and get it taken care of before it became a severe issue/emergency?

 

[krypton iodine sulfur]

It's time to drop the idea that fewer people will use the emergency room if everyone is insured (or we have a UHC system).

Not really. You could decide it's not worth the investment overall in trying to make it work as intended, but the same article points to failings in the current setup which could, hypothetically, be remedied for the long term.

Gerardi says one of the problems is that there aren't enough primary healthcare providers to handle the influx of newly insured patients. The trend is also a product of routine. Patients who find themselves newly insured may simply be comfortable with and used to visiting the emergency room.

 

[Axulus]

Whether you are insured or not, when you call a doctor's office in California, the first thing you get in a recorded message that if you are having a medical emergency, call 911. If more people are calling doctors because they are now insured, more people are hearing this message. The more people who hear this message, the more people are apt to call 911. The reason being that primary care physicians are overloaded and they cannot respond to problems rapidly. A call to 911 for medical assistance lands you in an emergency room, not your physicians's office. This MAY BE a contributing factor. It lines up with the alleged shortage of primary care physicians.

Yes, very plausible explanations. More people insured does not automatically translate into more primary care physicians (or greater supply of health care providers in general) sufficient to handle the increase in demand.

 

[Alcoholic Actuary]

It's time to drop the idea that fewer people will use the emergency room if everyone is insured (or we have a UHC system).

This evidence is consistent with the Oregon Medicaid health experiment (a much more robust study).

But according to a new poll of emergency healthcare professionals, that hasn't happened. In a survey conducted by the American College of Emergency Physicians (ACEP), more than of quarter of the 2,000-plus respondents said they had witnessed an increase in ER visitors in the last year.

Roughly 90 percent of the respondents said the severity of illness or injury among ER visitors has either increased or remained the same.

"The reliance on emergency care remains stronger than ever," Dr. Michael Gerardi, president of the ACEP, said in a press release.

http://www.upi.com/Health_News/2015...its-are-rising-under-Obamacare/2831430748684/

1) It has been 1 year. I don't think we need to "drop the idea" after 1 data point is established

2) People 'used' to go to the emergency room because it was the one place they could get treated regardless of their ability to pay. If they now go to the emergency room with insurance, then the hospital gets paid for the treatment it provides which still brings down the costs in aggregate.

aa

 

[ronburgundy]

So, it doesn't bother you that on a question where there are hospital records and reliable actual numbers that could have been used, this study instead used the purely subjective opinion survey of highly biased emergency room workers who want more funding and say in the same survey that they need it to handle increased patients? Not to mention the response rate was about 1% for most states, and complainers tend to be most likely to respond to such surveys.

Also, even if those subjective estimates are at all valid, 44% of the respondents said that the severity of cases was higher, while only 12% said it was lower.
IF the severity is higher, then that means people with less severe cases are in fact going to their primary care physician just just ACA predicted they would. The overall increase in numbers just means that more people have more severe ailments than last year year, which is hardly surprising since their are more people on the planet, plus severe ailments fluctuate from year to year. IOW, your research has massive validity issues, and even if valid is actually consistent with the non-straw man predictions of the ACA.

Which is why I said the Oregon Medicaid health study was far more robust.

You mean the study that found a 60% increase in the preventative care treatments, and better health outcome on every measure they collected? Unless you want to claim that our entire medical system in the US is useless, unscientific, and does nothing to improve or treat health conditions, then you must assume that this increase in preventative care and health would in fact reduce emergency room visits in the long-term. The overall very short-term greater ER visits is uninterpretable. First, it was only over 2 years and all theory predicts longer term impact than that. Second, because of a lifetime without insurance, many people are ignorant about the health care system and have almost never in their life received any treatment that wasn't in the ER. seen a primary care physician. You don't unlearn a lifetime of behavior in less than 2 years. It will take decades and educational intervention to undue culture of "wait until you need the ER" that was created by lifetimes and generations of people without insurance. But again, the fact that primary and prevtative care, and health status all showed some increases says that unless the care provided by US doctors is utterly useless, the long term benefit in reducing needless ER visits is still coming.

Furthermore, wasn't part of the selling point of Obamacare that more insured people would mean that there would be _fewer_ severe cases, as people with a potential health issue would see a doctor sooner and get it taken care of before it became a severe issue/emergency?

The evidence you presented supports that more people are seeing doctors prior to ER needs and that fewer non-emergency cases are going to the ER.
That will not translate into fewer ER visits overall in the short term, for the reasons discussed. In addition, it could easily be the case that the ER visits keep going up, but just not as much as they would have without ACA. More and more people could be doing more dangerous things (sports) and consuming dangerous products made by unethical corporations. This would increase ER rates per capita despite ACA having its predicted effect of increasing preventative care and reducing emergencies that would have occurred without it.
The real world is a messy and multi-causal place. X can impact Y via many pathways at once, some positive and some negative and that differ in their timecourse. Thus the simplistic numbers that ignore all these pathways and just looks at aggregate effects in the short term is near useless to test the theory. The most informative data is that about use of preventative and primary care. Combined with other data about preventative care in general, it says that things are going as expected due to ACA and that in the long term it will reduce costs associated with not getting care until it is a costly emergency.

 

[Loren Pechtel]

Whether you are insured or not, when you call a doctor's office in California, the first thing you get in a recorded message that if you are having a medical emergency, call 911. If more people are calling doctors because they are now insured, more people are hearing this message. The more people who hear this message, the more people are apt to call 911. The reason being that primary care physicians are overloaded and they cannot respond to problems rapidly. A call to 911 for medical assistance lands you in an emergency room, not your physicians's office. This MAY BE a contributing factor. It lines up with the alleged shortage of primary care physicians.

Not just California.


Besides, what we should be looking at is the number of ER visits that more appropriately should have been seen in a doctor's office instead.

 

[bilby]

It's time to drop the idea that fewer people will use the emergency room if everyone is insured (or we have a UHC system).

This evidence is consistent with the Oregon Medicaid health experiment (a much more robust study).

But according to a new poll of emergency healthcare professionals, that hasn't happened. In a survey conducted by the American College of Emergency Physicians (ACEP), more than of quarter of the 2,000-plus respondents said they had witnessed an increase in ER visitors in the last year.

Roughly 90 percent of the respondents said the severity of illness or injury among ER visitors has either increased or remained the same.

"The reliance on emergency care remains stronger than ever," Dr. Michael Gerardi, president of the ACEP, said in a press release.

http://www.upi.com/Health_News/2015...its-are-rising-under-Obamacare/2831430748684/

'More than a quarter' said more patients attended ER. Doesn't that imply that almost three quarters said patient numbers were either unchanged or reduced?

 

[ksen]

I am shocked that a union organization reported that their members are still relevant and needed.

 

[untermensche]

Of course.

If more people have health insurance more people will use all available heath care services.

Another success of Obamacare.

And of course a strawman argument. Nobody claimed that ER visits would be reduced.

What was claimed was that fewer people would show up to the ER without insurance.

 

[TV and credit cards]

Besides, what we should be looking at is the number of ER visits that more appropriately should have been seen in a doctor's office instead.

Maybe more walk-in clinics would help.

 

[coloradoatheist]

Of course.

If more people have health insurance more people will use all available heath care services.

Another success of Obamacare.

And of course a strawman argument. Nobody claimed that ER visits would be reduced.

What was claimed was that fewer people would show up to the ER without insurance.

There were claims of less ER visits, but Massachusets have seen them going down after a few years ago. The major claim is that Obamcare will save money in the end, and that's what is to be seen over the long run.

 

[untermensche]

Of course.

If more people have health insurance more people will use all available heath care services.

Another success of Obamacare.

And of course a strawman argument. Nobody claimed that ER visits would be reduced.

What was claimed was that fewer people would show up to the ER without insurance.

There were claims of less ER visits, but Massachusets have seen them going down after a few years ago. The major claim is that Obamcare will save money in the end, and that's what is to be seen over the long run.

Show me these alleged claims.

Because nobody in health care thought that.

In fact they thought the obvious. If more people have health insurance then there will be more ER visits.

Do more people have health insurance?

 

[laughing dog]

Which is why I said the Oregon Medicaid health study was far more robust. This new evidence isn't all that good but still consistent with the far more robust Oregon study.

According to your own Wiki link, the Oregon study is not terribly robust and has clear limited applicability. While that may make it more robust than anecdotal evidence, that is not saying very much at all.

I think it would be obvious that changing people's behavior is a long-term exercise. If people are used to going to the emergency room for all of their medical care, one would expect any noticeable change in that behavior to occur over longer periods of time than 2 years or less.

 

[arkirk]

There were claims of less ER visits, but Massachusets have seen them going down after a few years ago. The major claim is that Obamcare will save money in the end, and that's what is to be seen over the long run.

Show me these alleged claims.

Because nobody in health care thought that.

In fact they thought the obvious. If more people have health insurance then there will be more ER visits.

Do more people have health insurance?

There is a peculiar breakdown in the field of PRIMARY CARE. This is not an area in which the "go-getter" doctor chooses to work. Most of the people who can afford the medical training and time investment to become a doctor want to specialize and make bigger bucks. The student loan rip-off makes it even worse, where doctors need to make big bucks just to break even. Part of the high price of medical care is the underfunding of education in this country in the first place, compounded by the robbery of the student loan people. That gives us a dearth of basic care, commonly called General Practitioners in the old days.

When I was a boy and got sick, my parents could take me to a doctor, usually with only an hour or two notice...our doctor. Today, it may be at least a few days. Something is dramatically different in primary care. It now is 911 for the common people. Rich people have doctors in their retinue. Poor people and the middle class are always scratching to find a way through their problems they can afford. That is what made Obama's "Affordable Care" seem attractive. The problem is that most of medicine is still not affordable for most people.

The best time to be treated and observed...before you are sick...routine doctor visits. Medicare gives the patients the chance to do this with most of the Medicare Advantage plans. It, no doubt has improved the lives of many older patients...but even Medicare people are facing longer and longer waiting ques.