Emergency Department and Primary Care Use in Massachusetts 5 Years After Health Reform
UMass Chan AffiliationsPopulation and Quantitative Health Sciences
Graduate School of Biomedical Sciences
UMass Chan Analytics
Biostatistics and Health Services Research
Document TypeJournal Article
Keywordsaccess to care
state health reform
Health Services Administration
Health Services Research
MetadataShow full item record
AbstractOBJECTIVE: Conceptually, access to primary care (through insurance) should reduce emergency department (ED) visits for primary care sensitive (PCS) conditions. We sought to identify characteristics of insured Massachusetts residents associated with PCS ED use, and compare such use for public versus private insurees. POPULATION AND SETTING: People under age 65 in the Massachusetts All-Payer Claims Data, 2011-2012. STUDY DESIGN: Retrospective, observational analysis of PCS ED use with nonurgent, urgent/primary care treatable, and urgent/potentially avoidable visits being considered PCS. We predicted utilization in 2012 using multivariable regression models and data available in 2011 administrative records. PRINCIPAL FINDINGS: Among 2,269,475 nonelderly Massachusetts residents, 40% had public insurance. Among public insurees, PCS ED use was higher than for private (mean, 36.5 vs. 9.0 per 100 persons; adjusted risk ratio, 2.53; 95% confidence limits, 2.49-2.56), while having any primary care visit was less common (70% vs. 83%), as was having any visit to one's own (attributed) primary care provider (38% vs. 44%). CONCLUSIONS: Public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.
Med Care. 2019 Feb;57(2):101-108. doi: 10.1097/MLR.0000000000001025. Link to article on publisher's site
Permanent Link to this Itemhttp://hdl.handle.net/20.500.14038/46825
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