Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts

Jennifer Lee, Ru Ding, Scott Zeger, Aidan McDermott, Getachew Habteh-Yimer, Michael Chin, Rebecca S. Balder, Melissa L. McCarthy

Research output: Contribution to journalArticle

Abstract

Background: In 2006, Massachusetts expanded insurance coverage to many low-income individuals. Objectives: This study aimed to estimate the change in emergency department (ED) utilization per individual among a cohort who qualified for subsidized health insurance following the Massachusetts health care reform. Research Design: We obtained Massachusetts public health insurance enrollment data for the fiscal years 2004-2008 and identified 353,515 adults who enrolled in Commonwealth Care, a program that subsidizes insurance for low-income adults. We merged the enrollment data with statewide ED visit claims and created a longitudinal file that indicated each enrollee's ED visits and insurance status each month during the preenrollment and postenrollment periods. Measures: We estimated the ratio in an individual's odds of an ED visit during the postperiod versus preperiod by conditional logistic regression. Results: Among the 112,146 CommCare enrollees who made at least 1 ED visit during the study period, an individual's odds of an ED visit decreased 4% [odds ratio (OR) = 0.96; 95% confidence interval (CI), 0.94, 0.98] postenrollment. However, it varied significantly depending on preenrollment insurance status. A person's odds of an ED visit was 12% higher in the postperiod among enrollees not publicly insured prior (OR = 1.12; 95% CI, 1.10, 1.25), but was 18% lower among enrollees who transitioned from the Health Safety Net, a program that pays for limited services for lowincome individuals (OR = 0.82; 95% CI, 0.78, 0.85). Conclusions: Expanding subsidized health insurance did not uniformly change ED utilization for all newly insured low-income adults in Massachusetts.

Original languageEnglish (US)
Pages (from-to)38-44
Number of pages7
JournalMedical Care
Volume53
Issue number1
StatePublished - Jan 20 2015

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Insurance Coverage
Health Insurance
Hospital Emergency Service
Odds Ratio
Confidence Intervals
Health Care Reform
Insurance
Research Design
Public Health
Logistic Models
Safety
Health

Keywords

  • Emergency Department Utilization
  • Healthcare Reform
  • Massachusetts

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts. / Lee, Jennifer; Ding, Ru; Zeger, Scott; McDermott, Aidan; Habteh-Yimer, Getachew; Chin, Michael; Balder, Rebecca S.; McCarthy, Melissa L.

In: Medical Care, Vol. 53, No. 1, 20.01.2015, p. 38-44.

Research output: Contribution to journalArticle

Lee, J, Ding, R, Zeger, S, McDermott, A, Habteh-Yimer, G, Chin, M, Balder, RS & McCarthy, ML 2015, 'Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts', Medical Care, vol. 53, no. 1, pp. 38-44.
Lee, Jennifer ; Ding, Ru ; Zeger, Scott ; McDermott, Aidan ; Habteh-Yimer, Getachew ; Chin, Michael ; Balder, Rebecca S. ; McCarthy, Melissa L. / Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts. In: Medical Care. 2015 ; Vol. 53, No. 1. pp. 38-44.
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abstract = "Background: In 2006, Massachusetts expanded insurance coverage to many low-income individuals. Objectives: This study aimed to estimate the change in emergency department (ED) utilization per individual among a cohort who qualified for subsidized health insurance following the Massachusetts health care reform. Research Design: We obtained Massachusetts public health insurance enrollment data for the fiscal years 2004-2008 and identified 353,515 adults who enrolled in Commonwealth Care, a program that subsidizes insurance for low-income adults. We merged the enrollment data with statewide ED visit claims and created a longitudinal file that indicated each enrollee's ED visits and insurance status each month during the preenrollment and postenrollment periods. Measures: We estimated the ratio in an individual's odds of an ED visit during the postperiod versus preperiod by conditional logistic regression. Results: Among the 112,146 CommCare enrollees who made at least 1 ED visit during the study period, an individual's odds of an ED visit decreased 4{\%} [odds ratio (OR) = 0.96; 95{\%} confidence interval (CI), 0.94, 0.98] postenrollment. However, it varied significantly depending on preenrollment insurance status. A person's odds of an ED visit was 12{\%} higher in the postperiod among enrollees not publicly insured prior (OR = 1.12; 95{\%} CI, 1.10, 1.25), but was 18{\%} lower among enrollees who transitioned from the Health Safety Net, a program that pays for limited services for lowincome individuals (OR = 0.82; 95{\%} CI, 0.78, 0.85). Conclusions: Expanding subsidized health insurance did not uniformly change ED utilization for all newly insured low-income adults in Massachusetts.",
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AB - Background: In 2006, Massachusetts expanded insurance coverage to many low-income individuals. Objectives: This study aimed to estimate the change in emergency department (ED) utilization per individual among a cohort who qualified for subsidized health insurance following the Massachusetts health care reform. Research Design: We obtained Massachusetts public health insurance enrollment data for the fiscal years 2004-2008 and identified 353,515 adults who enrolled in Commonwealth Care, a program that subsidizes insurance for low-income adults. We merged the enrollment data with statewide ED visit claims and created a longitudinal file that indicated each enrollee's ED visits and insurance status each month during the preenrollment and postenrollment periods. Measures: We estimated the ratio in an individual's odds of an ED visit during the postperiod versus preperiod by conditional logistic regression. Results: Among the 112,146 CommCare enrollees who made at least 1 ED visit during the study period, an individual's odds of an ED visit decreased 4% [odds ratio (OR) = 0.96; 95% confidence interval (CI), 0.94, 0.98] postenrollment. However, it varied significantly depending on preenrollment insurance status. A person's odds of an ED visit was 12% higher in the postperiod among enrollees not publicly insured prior (OR = 1.12; 95% CI, 1.10, 1.25), but was 18% lower among enrollees who transitioned from the Health Safety Net, a program that pays for limited services for lowincome individuals (OR = 0.82; 95% CI, 0.78, 0.85). Conclusions: Expanding subsidized health insurance did not uniformly change ED utilization for all newly insured low-income adults in Massachusetts.

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