Young Adults May Be Less Likely to Use ED When Insured

Having access to health insurance is slowing the rate of young adults who head to the emergency department for care, a new study suggests. Relative use of the ED decreased among 19- to-25-year-olds after the healthcare reform law allowed them to stay on their parents’ policies. The authors say the results show insurance can reduce ED overuse by removing the economic barriers to preventive care.

“It’s possible that when people have healthcare insurance they are less worried about the financial costs of care,” said Tina Hernandez-Boussard, assistant professor of surgery and biomedical informatics at Stanford University and lead author of a study published Monday in the journal Health Affairs. “They might seek appropriate care elsewhere and take care of conditions earlier. This could lead to a reduction in utilization of the emergency department.”

Health insurers were required under the Patient Protection and Affordable Care Act to allow young adults ages 19-25 to retain coverage through a parent’s employee-sponsored and individual plans effective Sept. 23, 2010. To evaluate the impact of that provision, Hernandez-Boussard and colleagues looked at ED use among young adults ages 19-31 before the provision took effect (Sept. 1, 2009, through Aug. 31, 2010) and after (Jan. 1 through Dec. 31, 2011) in three U.S. states: California, New York and Florida.

After the law went into effect, patients ages 19 to 25 had an absolute decrease of 2.7 emergency department visits per 1,000 people compared with their slightly older counterparts who did not benefit from the provision. The study also found a 2.9% decrease in those reporting as self paying when they visited the ED among the age group that qualified for the provision, compared with a 0.6% decrease among the older cohort.

But even though the relative rates of visits to the ED slowed, the reductions in overall use were minimal, Hernandez-Boussard said, which suggests more research is needed to understand the utilization patterns. “Young adults might still see the ED as an immediate care facility,” she said. “If we look more into how they are still using the ED and what they are coming in for, that would be very helpful in developing further policies to address these users.”

The sample—drawn from state inpatient and emergency department databases of the AHRQ’s Healthcare Cost and Utilization Project—included records of more than 10 million visits by nearly 6 million young adult patients.

Young adults ages 18 to 34 are the most likely to be without health insurance coverage and accounted for 41% of the 41.3 million uninsured eligible for Medicaid or plans sold on the Obamacare insurance exchanges, according to a 2013 report from HHS’ Office of the Assistant Secretary for Planning and Evaluation.

As 18- to 25-year-olds became eligible to stay on their parents’ insurance policies and then gained greater access to their own coverage through Medicaid and the insurance exchanges, the percentage who lacked coverage dropped from 28% in 2010 to 18.7% in the second quarter of this year, according to a Gallup and Healthways poll. The uninsured rate for 26- to 34-year-olds, meanwhile, dropped to 23.9% this year from 30.2% before the law’s coverage provisions went into effect.

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