The 2013 Colorado Health Access Survey (CHAS) shows that 21.5 percent of children on public insurance visited the emergency department for a non-emergency in 2013. This rate is three times higher than emergency department use for non-emergencies by children who lack insurance – a significant difference. Commercially insured kids visited for non-emergencies at a rate similar to the uninsured.
Given that the estimate of publicly insured children was 362,000 in 2013, this means about 77,300 children visited the emergency room for a non-emergency last year.
We think that cost may play a role in the surprising variation in utilization rates between uninsured children and those with public insurance. With lower out-of-pocket costs to use the service for those with public insurance such as Medicaid or Child Health Plan Plus (CHP+), it can be expected that the frequency of use will increase.
These data are not surprising when viewed in light of results from a study released last week by researchers in Oregon. That study revealed that emergency department use increases when uninsured people get coverage. Researchers found that Medicaid enrollees used the emergency room an average of 1.43 times during the 18 months after their coverage began, 40 percent more than the average 1.02 visits per person in the control group.
Though the CHAS results mirror some of the Oregon findings, it is important to note that there are differences in the methods of the two studies. The CHAS uses self-reported data while the Oregon study used hospital administrative data.
We will continue to use the CHAS to evaluate whether findings nationally or in other states are similar to those in Colorado. This analysis will be especially pertinent this year as the Medicaid expansion takes effect for adults and more Coloradans are covered by public insurance.