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Most Medicaid Patients Visit Emergency Departments for Urgent or Worse Symptoms

According to a new report released by the Center for Studying Health System Change (HSC), the majority of adult Medicaid patients who seek emergency care do so for potentially urgent medical needs. The HSC report challenges the widely held assumption that Medicaid patients go to emergency departments for routine or non-urgent care.

Unlike some other studies and anecdotal evidence, the HSC report looked at patients’ symptoms instead of their final diagnoses. Dr. David Seaberg, President of the American College of Emergency Physicians, pointed out that this is an important distinction in emergency medicine.

“If you have the symptoms of chest pain, you should seek emergency care. And if it turns out that your chest pain was a non-urgent condition, such as a hiatal hernia, then your health insurance plan should still cover it. This is called the prudent layperson standard, which Congress enacted in 1997 and then included in the Affordable Care Act. Emergency physicians fought for decades to make sure this standard was a law because patients should never be diagnosing themselves.”

By using a research model more consistent with the prudent layperson standard, HSC found that Medicaid patients seek care at emergency departments for serious symptoms at a rate comparable to patients with private insurance.

The report does find, however, that Medicaid patients use emergency departments at a rate more than double that of adults with private insurance. In a press release, Dr. Seaberg explains that this is because many find it difficult to find doctors willing to accept Medicaid. As a result, these patients have little choice but to wait until their health problems become so serious that they require emergency care.

Many doctors do not accept Medicaid because of the comparably low reimbursement rates. Until policymakers fix this problem, Medicaid patients will have few viable options for care outside of emergency facilities. Dr. Seaberg added, “It isn’t fair to say ‘don’t go to the emergency room’ without providing available medical alternatives, which currently are woefully inadequate.”

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