Presented By: Health, History, Demography and Development (H2D2)
Health, History, Demography & Development (H2D2)
White Follows Green Revisited: Effect of Medicaid Expansion on Diagnoses and Procedures presented by Shooshan Danagoulian, Wayne State University
Abstract:
The expansion of Medicaid under the ACA has extended health insurance to millions of previously uninsured low income adults. This paper analyzes the effect of this expansion of insurance on medical treatment received in the emergency department. It uses State Emergency Department Database (SEDD) discharge data from 2013 to 2014 to estimate the effect of the change in insurance on duration of stay, number of procedures performed, number of diagnoses recorded, and the average charge per procedure for all and subgroups of patients in the emergency department. Using a difference-in-differences model, we compare the outcome variables in expanding states to those in non-expanding states. We find that the changes in treatment are not limited to those with newly acquired Medicaid coverage. Duration of stay declines up to 49 minutes for the young and the elderly, while it increases by up to 8 minutes for the working age adults. The number of procedures increases for all patients in expanding states by up to 0.33 procedures, for young, working age adults, and elderly. The number of diagnoses, meanwhile, declines between .05 to 0.27 diagnoses for all groups. The estimates are robust to specification and propensity matching of patients in expanding and non-expanding states. These results suggest that health insurance expansion is likely to result in increase in intensity of treatment in the emergency room for all patients, irrespective of insurance status. With the average charge for procedure at $721 in our data, the increase in the number of procedures for Medicaid the three states our analysis corresponds to additional $227 million in charges, which constitutes 7.3% of the total increase in Medicaid expenditure in these states between 2013 and 2014. These estimates suggest that the costs associated with expanding insurance coverage should include those associated with changes in treatment of patients. These costs are not limited to Medicaid, as they extend to patients with private insurance, Medicare, and self-paying patients.
The expansion of Medicaid under the ACA has extended health insurance to millions of previously uninsured low income adults. This paper analyzes the effect of this expansion of insurance on medical treatment received in the emergency department. It uses State Emergency Department Database (SEDD) discharge data from 2013 to 2014 to estimate the effect of the change in insurance on duration of stay, number of procedures performed, number of diagnoses recorded, and the average charge per procedure for all and subgroups of patients in the emergency department. Using a difference-in-differences model, we compare the outcome variables in expanding states to those in non-expanding states. We find that the changes in treatment are not limited to those with newly acquired Medicaid coverage. Duration of stay declines up to 49 minutes for the young and the elderly, while it increases by up to 8 minutes for the working age adults. The number of procedures increases for all patients in expanding states by up to 0.33 procedures, for young, working age adults, and elderly. The number of diagnoses, meanwhile, declines between .05 to 0.27 diagnoses for all groups. The estimates are robust to specification and propensity matching of patients in expanding and non-expanding states. These results suggest that health insurance expansion is likely to result in increase in intensity of treatment in the emergency room for all patients, irrespective of insurance status. With the average charge for procedure at $721 in our data, the increase in the number of procedures for Medicaid the three states our analysis corresponds to additional $227 million in charges, which constitutes 7.3% of the total increase in Medicaid expenditure in these states between 2013 and 2014. These estimates suggest that the costs associated with expanding insurance coverage should include those associated with changes in treatment of patients. These costs are not limited to Medicaid, as they extend to patients with private insurance, Medicare, and self-paying patients.
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