Citation

Tsega S, Cho HJ. JAMA Netw. Open 2019; 2(6): e196856.

Affiliation

Lown Institute, Brookline, Massachusetts.

Copyright

(Copyright © 2019, American Medical Association)

DOI

10.1001/jamanetworkopen.2019.6856

PMID

31251373

Abstract

Research suggests that an increase in insurance coverage is associated with increased use of health care services. This should make intuitive sense. Individuals who were previously unable to afford health care services would seek them out once affordability was no longer an issue. This was demonstrated in several situations, including the expansion of Medicaid in Oregon and the introduction of an individual mandate and expansion of heavily subsidized insurance in Massachusetts, both of which predated the Patient Protection and Affordable Care Act (ACA). These same instances also provided examples of increases in inappropriate health care use, defined as patients seeking nonurgent care in the emergency department.

Courtemanche et al present a unique example of increased use associated with the implementation of the ACA. In this case-control study, the authors reviewed ambulance dispatch reports in New York City (NYC), New York, comparing low-severity with high-severity dispatches as defined by the city’s emergency medical services (EMS) Incident Dispatch Data. For the period evaluated, the authors show that there was a relative increase of 37.2% in dispatches for nonsevere or minor injuries.4 The authors posit that this increase was the result of the ACA “insulating patients from having to pay full cost”4 and suggest that there might be “appropriate incentives” (we presume via cost sharing) to decrease use of unnecessary emergency services ...

Language: en