Emergency department usage in Massachusetts rose slightly both during and immediately after implementation of a 2006 state law expanding healthcare access, a sign that broader availability of insurance may increase use of the ED, Beth Israel Deaconess Medical Center researchers report in a study published in the Annals of Emergency Medicine.

The review of 13.3 million visits from 2004-2009 suggests multiple factors--including access to primary care, pent-up demand for healthcare services, and the 24-hour availability and perceived efficiency of care in the ED–must also be weighed in assessing the likely impact of the federal Affordable Care Act on ED use.

Lead author Peter Smulowitz, M.D., and colleagues found ED usage increased by as much as 1.2 percent between Oct. 1, 2006 and Sept. 30, 2007 after Massachusetts implemented its first-in-the-nation law to increase healthcare access. That rose to a 2.2 percent increase in ED usage for the period that ended Sept. 30, 2009.

The data included all ED visits in Massachusetts submitted annually from 69 acute care hospitals, accounting for approximately 2 million outpatient ED visits, 850,000 inpatient admissions, and 150,000 observation stays.

“Our findings are consistent with a recent study of Medicaid expansion in Oregon that also demonstrated a substantial increase in ED use by those who obtained insurance,” senior author Bruce Landon, M.D., of the Department of Health Care Policy of Harvard Medical School, said in a written statement accompanying the publication of the research results.

“This growing body of evidence suggests that as the Affordable Care Act is implemented, states, particularly those expanding their Medicaid programs, and providers of emergency care should anticipate increased demand from patients and plan accordingly.”

The study also confirms other recent data that the percentage of ED visits made by the uninsured is proportional to the rate of uninsured in the population, although the reasons for ED visits differ between those who have insurance and those who do not.

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