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ED Visits Down a Bit In Mass. Reform Effort

Despite policymakers’ hopes to the contrary, passage of the Massachusetts health care reform law resulted in only a minimal drop in low-severity visits to the state’s emergency departments, say researchers from Beth Israel Deaconess Medical Center. Overall ED use continued to rise, however. Findings were published in the Annals of Emergency Medicine.

This small decrease in low-severity visits was somewhat contradictory to expectations before the implementation of reform, says Peter Smulowitz, MD, MPH, the study’s lead author and an emergency physician at the center. “To the extent that policymakers expected a substantial decrease in overall and low-severity ED visits, this study does not support those expectations.”

Inadequate availability of primary care may be a key reason for the reform’s failure to control ED utilization. In addition, “Even with adequate coverage, it might take time and effort to alter care-seeking patterns that have become ingrained in some communities,” Smulowitz says. “Many of these patients had never had insurance before, so they may have been relying on the ED instead of other care settings.”

Researchers found a 4.1 percent increase in overall ED visits from 2006 to 2008 — 3.4 percent from 2006 to 2007 and 0.7 percent the following year. In comparison, there was a 4.6 percent increase in ED visits statewide, according to data from the Massachusetts Division of Health Care Finance and Policy. They found a 1.8 percent decrease in low-severity visits for the group affected by the reform law versus the comparison group.

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