Abstract
The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 271-277 |
| Number of pages | 7 |
| Journal | Population Health Management |
| Volume | 20 |
| Issue number | 4 |
| DOIs | |
| State | Published - Aug 1 2017 |
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Keywords
- Emergency Department Use
- Medicaid Patients
- Non-Linear Blinder-Oaxaca Decomposition
ASJC Scopus subject areas
- Leadership and Management
- Health Policy
- Public Health, Environmental and Occupational Health
Cite this
Comparing Emergency Department Use among Medicaid and Commercial Patients Using All-Payer All-Claims Data. / Kim, Hyunjee; McConnell, Kenneth (John); Sun, Benjamin.
In: Population Health Management, Vol. 20, No. 4, 01.08.2017, p. 271-277.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Comparing Emergency Department Use among Medicaid and Commercial Patients Using All-Payer All-Claims Data
AU - Kim, Hyunjee
AU - McConnell, Kenneth (John)
AU - Sun, Benjamin
PY - 2017/8/1
Y1 - 2017/8/1
N2 - The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.
AB - The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.
KW - Emergency Department Use
KW - Medicaid Patients
KW - Non-Linear Blinder-Oaxaca Decomposition
UR - http://www.scopus.com/inward/record.url?scp=85026329232&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85026329232&partnerID=8YFLogxK
U2 - 10.1089/pop.2016.0075
DO - 10.1089/pop.2016.0075
M3 - Article
C2 - 28075692
AN - SCOPUS:85026329232
VL - 20
SP - 271
EP - 277
JO - Population Health Management
JF - Population Health Management
SN - 1942-7891
IS - 4
ER -