Does health insurance and seeing the doctor keep you out of the hospital?

Chanel Weaver | Army Medicine

Capt. David Kassop sees a patient at the Edgewood Troop Medical Clinic at Aberdeen Proving Ground Sep. 13

Article Highlights

  • Evidence is divided on likelihood of emergency room visits for patients with or without health insurance

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  • Estimated 5 million hospital visits totaling $26.5 billion could have been prevented with better primary care

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"Our health care system has forced too many uninsured Americans to depend on the emergency room for the care they need," said Secretary Sebelius. "We cannot wait for reform that gives all Americans the high-quality, affordable care they need and helps prevent illnesses from turning into emergencies."

"The preventive care that primary care physicians provide can help to reduce hospitalization rates. In 2000, an estimated 5 million admissions to U.S. hospitals, with a resulting cost of more than $26.5 billion, may have been preventable with high-quality primary and preventive care treatment." (p. 5, Zerehi 2008)

The underlying logic of these two quotes is consistent with most people’s intuition, which is that health insurance lowers the cost of medical care services and encourages consumers to obtain more timely and appropriate care from primary care doctors. In turn, this greater use of primary care services keeps people healthier and out of emergency rooms and hospitals. Moreover, the belief that health insurance and the increased use of primary care associated with it leads to fewer hospitalizations has played an important role in the recent health care reform debate, as illustrated by the quote from Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services. Indeed, increased access to primary care is emphasized in the Patient Protection and Affordable Care Act, which includes several programs to expand the supply and use of primary care services (Abrams et al., 2011).

While it is plausible that health insurance and greater use of primary care can reduce emergency room use and hospitalization, there is a substantial amount of empirical evidence that is inconsistent with this hypothesis. For example, a recent study by researchers from the Centers for Disease Control and Prevention showed that those who are uninsured are no more likely to use the emergency room than those with health insurance (Garcia et al., 2010). A similar conclusion was reached by Newton et al. (2008) who reviewed 127 studies that examined correlates of use of emergency department services.

Robert Kaestner is a visiting scholar at AEI.

Anthony Lo Sasso is a professor Health Policy and Administration at the University of Illinois at Chicago.

 

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