Health care utilization rates after Oregon's 2008 Medicaid expansion

Jean P. O'Malley, Maureen O'Keeffe-Rosetti, Robert (Bob) Lowe, Heather Angier, Rachel Gold, Miguel Marino, Brigit Hatch, Megan Hoopes, Steffani Bailey, John Heintzman, Charles Gallia, Jennifer Devoe

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Although past research demonstrated that Medicaid expansions were associated with increased emergency department (ED) and primary care (PC) utilization, little is known about how long this increased utilization persists or whether postcoverage utilization is affected by prior insurance status. Objectives: (1) To assess changes in ED, PC, mental and behavioral health care, and specialist care visit rates among individuals gaining Medicaid over 24 months postinsurance gain; and (2) to evaluate the association of previous insurance with utilization. Methods: Using claims data, we conducted a retrospective cohort analysis of adults insured for 24 months following Oregon's 2008 Medicaid expansion. Utilization rates among 1124 new and 1587 returning enrollees were compared with those among 5126 enrollees with continuous Medicaid coverage (≥1 y preexpansion). Visit rates were adjusted for propensity score classes and geographic region. Results: PC visit rates in both newly and returning insured individuals significantly exceeded those in the continuously insured in months 4 through 12, but were not significantly elevated in the second year. In contrast, ED utilization rates were significantly higher in returning insured compared with newly or continuously insured individuals and remained elevated over time. New visits to PC and specialist care were higher among those who gained Medicaid compared with the continuously insured throughout the study period. Conclusions: Predicting the effect of insurance expansion on health care utilization should account for the prior coverage history of new enrollees. In addition, utilization of outpatient services changes with time after insurance, so expansion evaluations should allow for rate stabilization.

Original languageEnglish (US)
Pages (from-to)984-991
Number of pages8
JournalMedical Care
Volume54
Issue number11
DOIs
StatePublished - Oct 1 2016

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Patient Acceptance of Health Care
Medicaid
Primary Health Care
Insurance
Hospital Emergency Service
Propensity Score
Insurance Coverage
Emergency Medical Services
Ambulatory Care
Mental Health
Cohort Studies
Delivery of Health Care
Research

Keywords

  • access to care
  • health care utilization
  • Medicaid
  • policy evaluation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Health care utilization rates after Oregon's 2008 Medicaid expansion. / O'Malley, Jean P.; O'Keeffe-Rosetti, Maureen; Lowe, Robert (Bob); Angier, Heather; Gold, Rachel; Marino, Miguel; Hatch, Brigit; Hoopes, Megan; Bailey, Steffani; Heintzman, John; Gallia, Charles; Devoe, Jennifer.

In: Medical Care, Vol. 54, No. 11, 01.10.2016, p. 984-991.

Research output: Contribution to journalArticle

O'Malley, JP, O'Keeffe-Rosetti, M, Lowe, RB, Angier, H, Gold, R, Marino, M, Hatch, B, Hoopes, M, Bailey, S, Heintzman, J, Gallia, C & Devoe, J 2016, 'Health care utilization rates after Oregon's 2008 Medicaid expansion', Medical Care, vol. 54, no. 11, pp. 984-991. https://doi.org/10.1097/MLR.0000000000000600
O'Malley, Jean P. ; O'Keeffe-Rosetti, Maureen ; Lowe, Robert (Bob) ; Angier, Heather ; Gold, Rachel ; Marino, Miguel ; Hatch, Brigit ; Hoopes, Megan ; Bailey, Steffani ; Heintzman, John ; Gallia, Charles ; Devoe, Jennifer. / Health care utilization rates after Oregon's 2008 Medicaid expansion. In: Medical Care. 2016 ; Vol. 54, No. 11. pp. 984-991.
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