Changes in Emergency Department Use Among Young Adults After the Patient Protection and Affordable Care Act’s Dependent Coverage Provision - 24/05/15
, Kosali Simon, PhD b, d, Benjamin D. Sommers, MD, PhD e, fAbstract |
Study objective |
Since September 2010, the Patient Protection and Affordable Care Act has allowed young adults to remain as dependents on their parents’ private health plans until age 26 years. This insurance expansion could improve the efficiency of medical care delivery by reducing unnecessary emergency department (ED) use. We evaluated the effect of this provision on ED use among young adults.
Methods |
We used a nationally representative ED visit database of more than 17 million visits from 2007 to 2011. Our analysis compared young adults aged 19 to 25 years (the age group targeted by the law) with slightly older adults aged 27 to 29 years (control group), before and after the implementation of the law.
Results |
The quarterly ED-visit rate decreased by 1.6 per 1,000 population (95% confidence interval 1.2 to 2.1) among targeted young adults after the implementation of the provision, relative to a comparison group. The decrease was concentrated among women, weekday visits, nonurgent conditions, and conditions that can be treated in other settings. We found no effect among weekend visits or visits due to injuries or urgent conditions. The provision also changed the health insurance composition of ED visits; the fraction of privately insured young adults increased, whereas the fraction of those insured through Medicaid and those uninsured decreased.
Conclusion |
The Patient Protection and Affordable Care Act dependent coverage expansion was associated with a statistically significant yet modest decrease in ED use, concentrated in the types of ED visits that were likely to be responsive to changes to insurance status. In response to the law, young adults appeared to have altered their visit pattern to reflect a more efficient use of medical care.
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| Please see page 665 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Melissa L. McCarthy, ScD |
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| Author contributions: All authors conceived and designed the study, analyzed and interpreted the data, performed statistical analysis, drafted the article, and contributed substantially to its revision. YAA and ASM acquired the data. KS takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: Dr. Sommers currently serves part-time as an advisor in the US Department of Health and Human Services, but this article was written in his capacity as a Harvard University employee. |
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| The views expressed in this article are those of the authors and do not represent the views of the Department of Health and Human Services or the Agency for Healthcare Research and Quality. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 65 - N° 6
P. 664 - juin 2015 Retour au numéro
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