Some research reports out this week appear to bolster the arguments of those who advocate shrinking Medicare and Medicaid programs in order to cut health care costs. One study, reported in the New York Times, found that people newly insured under Medicaid tended to increase their use of emergency departments. Exactly the opposite of what many people expected.
Two other studies reviewed hospital readmissions: a new CMS report showed that eight percent of hospitals, including the revered Cleveland Clinic, had hospital readmission rates higher than average. And a recent study in Health Services Research found that hospitals serving so-called dual eligibles, people old enough to qualify for Medicare and poor enough to qualify for Medicaid, tended to have higher rates of readmissions, putting hospitals at risk for penalties from CMS under their Hospital Readmission Reduction Program.
Underlying all of these reports is the fact that for many people, especially those with low incomes, the hospital is the only place where they can receive care when they need it — either because they can't get an appointment or their physician won't accept Medicaid or because the hospital is the only place equipped to deal with health complications brought on by multiple chronic illnesses.
Without convenient access to a primary care physician or other health care provider, people without and with insurance, be it private or government-sponsored, return to the emergency department or hospital out of need and desperation.
One key to reducing costly emergency room visits and readmissions is to provide low-income patients with flexible alternatives such as community health centers. Another recent study in Health Services Research found that areas with well-funded community health centers had Medicaid users who relied less on emergency departments for care.
Until all people are informed about where they can go for immediate care, and provided with convenient options for after-hours and weekend health care, hospital emergency departments will continue to have to pick up the slack.