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Frequent ED users often have insurance, doctors

Expanding insurance coverage could increase emergency department use, a study concludes.

By Doug Trapp — Posted April 8, 2010

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People who visit emergency departments at least four times a year generally are white, and have health insurance and a primary care physician, according to a study in the March Annals of Emergency Medicine.

Frequent users account for about 8% of ED patients but 28% of visits. Although frequent users are not a homogeneous group, 60% are white and their average age is 40. Roughly 60% are enrolled in Medicare or Medicaid, according to the article, "Frequent Users of Emergency Departments: The Myths, the Data and the Policy Implications." The analysis is based on a review of 25 studies of ED use published since 1990.

The uninsured do not dominate EDs; 15% of frequent ED visitors have no coverage, the study found. Only about 2% of uninsured adults visit an ED four or more times in a year.

The study's authors also concluded that most frequent ED users have primary care physicians, though findings about patients' actual access to that care are inconclusive.

Increasing access to health insurance, whether public or private, could increase the number of people frequently visiting EDs, the authors conclude.

Coverage expansions in the Patient Protection and Affordable Care Act -- signed by President Obama March 23 -- will boost ED visits, said American College of Emergency Physicians President Angela Gardner, MD. Starting in 2014, the act expands Medicaid eligibility to people earning 133% of poverty. The act also requires health plans in state insurance exchanges to provide emergency care without prior authorization and in spite of any contractual relationships plans have with emergency physicians. The ACEP has long advocated for this kind of national "prudent layperson standard," she said. However, insurance exchanges won't be available in many states until 2014.

ED visits recently have increased in Massachusetts, whose 2006 universal coverage law is a model for the national health reform bill. "Critical problems facing emergency patients are not going away," Dr. Gardner said.

The study is available online (link).u

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