A couple years ago I wrote about a study which found that most people seeking care in emergency rooms had health insurance – contrary to popular belief that ER overcrowding is due to the uninsured population seeking primary care in the ER. One of the things I noted about the study was that across all age groups, far more people insured by Medicaid were visiting the ER than those insured by private health insurance and those with no health insurance at all.
A new study conducted by the University of Colorado has similar findings and also predicts a large increase over the next decade in the number of Medicaid patients using the ER. Dr. Adit Ginde, the lead author of the study, noted that Medicaid patients tend to be in worse health than people with private health insurance, but that they also have more barriers preventing them from seeing a primary care physician (I’ve written about how the PCP shortage is more acutely felt if a person has Medicaid instead of private health insurance).
The CU study looked at survey responses of nearly a quarter of a million adults over the past decade. They found that Medicaid patients were nearly twice as likely as patients with private health insurance to report having at least one barrier preventing them from receiving primary care (16.3% versus 8.9% respectively).
Dr. Ginde’s study pointed out that over the next ten years, 16 million people are expected to enroll in Medicaid. Since it’s more difficult for Medicaid patients to obtain primary care outside of an emergency room setting, the increase in Medicaid enrollment is likely to worsen the ER overcrowding situation. The PCP shortage is far more of a problem for those with Medicaid, since not all doctors accept new Medicaid patients. These patients are left with few options for care – despite technically having health insurance – and are thus more likely to end up in the emergency room.
The results of these studies are a convincing argument in favor of the model that has been used in Grand Junction, Colorado since the 70’s. Instead of being reimbursed on an individual basis by each patient’s health insurance carrier, doctors in Grand Junction agreed long ago to simply pool the reimbursements from private health insurance, Medicare, and Medicaid. From that pool of money, the doctors are paid equally for every patient they see, regardless of whether that patient has private health insurance or Medicaid. Medicaid reimbursements are lower than those of private health insurance, so it’s understandable that many doctors prefer to see patients with private health insurance. But the system in Grand Junction focuses on what’s best for the community and does away with the financial incentive to see privately insured patients rather than those with Medicaid.
Perhaps implementation of a similar model in other cities could help to improve Medicaid patients’ access to primary care and cut down on ER overcrowding.
