Medicaid Recipients Twice as Likely to be ED Patients


A study just published in the Annals of Emergency Medicine shows something that many people suspected: Patients with Medicaid (i.e. government “insurance”) tend to use the emergency department much more often than patients with private insurance.

After studying 230,000 participants in the National Health Interview Survey, the researchers found that Medicaid patients were more than twice as likely to use the emergency department as their privately-insured counterparts. When barriers to timely primary care were added into the picture (including difficulty reaching doctor on telephone, difficulty obtaining timely appointment, long waits in the physician’s office, limited clinic hours, and lack of transportation), emergency department utilization increased significantly. 40% of Medicaid patients had used the emergency department more than once in the prior year. 51% of Medicaid patients with one barrier had more than one ED visit in the prior year and 61% of patients with two or more barriers had more than one ED visit in the prior year.

I’m sure that there are other reasons for the higher than normal emergency department utilization, the biggest one being lack of a disincentive for using emergency departments versus primary care physicians.

The article concluded that “Expansion of Medicaid eligibility alone may not be sufficient to improve health care access.”

Insurance doesn’t equal access. Wonder where I’ve heard that before ….


  1. MamaOnABudget on

    I think there are also HUGE disincentives to use the ED with regular insurance. I know when we were insured (not at all now – state or otherwise), we had really good coverage… but a $500 deductible to be paid in cash up front if you weren’t admitted. I went through (what we now know were) horrible gall stones passing while I was 30+ weeks pregnant. Our family was begging us to go to the ED to be checked out, but we didn’t have $500 cash. Obviously I lived to tell about it, but I also had attacks over and over again until after birth (and saw my FP multiple times for them before and after baby).

    I’m sure the questions is, “So…?” But it’s scary to be in those shoes where you’re insured but have the additional worry of not having grocery or utility money for the rest of the month if it’s serious enough to go to the hospital but not serious enough to stay.

    • I don’t think a $500 deductible if you aren’t admitted is fair, either, because it does put most people in the position of having to choose between their health and paying for basic necessities.
      How are average people supposed to know whether or not something would potentially require admission? Many doctors can’t decide in some cases.

    • It’s really to bad you had to suffer so much over this problem, MOB, but it was unnecessary. I can’t imagine any ER turning away a patient in obvious distress because they don’t have the cash up front. If there is such a place I’d like to know about it because I will have found a quick way to get rich with a hefty lawsuit. I have a lawyer friend that would salivate over such a prospect.
      I agree that the $500 co-pay is ridiculous.

  2. I have private insurance, and no way would I go to the emergency room unless I was at death’s door. I have a $1000 deductible to meet before my insurance pays, and I don’t think I’ve ever met that deductible. My insurance does, however, cover 4 doctor visits per year separate from the deductible. Thus I save any visits to expensive specialists for January. And for all the normal stuff I see my GP.

  3. i remember some years ago some ED physician told this story about how his boss, another ED physician, went to his PCP with some not-too-emergent complaint, avoiding the ED because (he thought) he knew better than to go to the ED since he wasn’t dying right away.

    without recalling specific details anymore, basically, because he had an HMO plan, his PCP referred him to one specialist after another, resulting in 4 appointments with 4 different offices over several days before he finally had everything sorted out.

    whereas if he had simply gone to the ED right at the start with his not-too-emergent complaint like many medicaid folks, the ED would have been able to take care of all of it, even if the original complaint was not emergent.

    the physician who told this story loved the irony.

    “the people who abuse the ED are stupid? no, they’re SMART!”

    • WOW! One ED doc, caring for 8 or ten patients at the same time, is apparently smarter than one FP and three specialists. Thanks for the compliment bom, but I’m afraid I can’t perform at that level with every patient. Often, the best I can do is r/o serious or life-threatening diagnoses and tell the pt. to see their PCP.

  4. “Insurance doesn’t equal access.”

    So what does? When you look at the states with the most physicians per capita, what do they have in common?

  5. Second Thought on

    Transportation and cost are the main reasons patients choose the ED. An ambulance will come and take them there and they will be seen even if they have no money on them. Do any clinics provide the same door-to-door service with no money upfront?

  6. Kept reading “ED” as Erectile Dysfunction.

    For a moment I was wondering if this wasn’t a covert solution to the Marching Morons problem. “If the poor are unable to procreate then we won’t have to worry about them crowding out the smart people!”

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