Medicaid Patients Struggle to Get Primary Care, Visit ERs More

By: Annals of Emergency Medicine
By: Annals of Emergency Medicine


Twice as many people insured by Medicaid as by private insurance report barriers to primary care and Medicaid patients are twice as likely to visit the emergency department as their privately insured counterparts, according to a study published online yesterday in Annals of Emergency Medicine (“National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries”)

“Even those Medicaid patients who have primary care physicians – and that is less likely than for people with private insurance – report significant barriers to seeing their doctor,” said senior author Adit Ginde, M.D., MPH, FACEP, of the University of Colorado School of Medicine in Aurora, Colo. “Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall. But they also visit the ER more because they can’t see their primary care provider in a timely fashion or at all.”

The study authors analyzed 230,238 adult responses to the 1999-2009 National Health Interview Survey for an association between barriers to primary care and use of the emergency department. Overall, 16.3 percent of Medicaid beneficiaries had one or more barriers to primary care, compared to 8.9 percent of people with private insurance. More than one-third (39.6 percent) of Medicaid patients visited the ER within the last year versus 17.7 percent of privately insured patients.

“Our findings are particularly worrisome in light of the additional 16 million people who will be added to the Medicaid rolls over the next decade,” said Dr. Ginde. “The shortage of primary care providers in the U.S. seems to affect Medicaid patients disproportionately and more harshly.”

Even comparing patients with barriers to primary care side by side, Medicaid beneficiaries were still more likely to visit the emergency department than those with private insurance (61.2 percent v. 28.9 percent for patients with two or more barriers to primary care). Barriers included not being able to reach a doctor by phone, not being able to get a timely appointment and lack of transportation to the doctor’s office.

“The efforts by some states to keep Medicaid patients out of the ER do not take this lack of access to primary care into account,” said David Seaberg, M.D., FACEP, president of the American College of Emergency Physicians. “It puts both patients and providers into an impossible position that will only get worse as more people enroll in Medicaid.”

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  • by Hannah on Mar 15, 2012 at 03:55 AM
    Why should a doctor HAVE to take a Medicare patient? They have the option of accepting some insurance and not others. If NoBama cares go through everyone will be waiting weeks,months and maybe years for basic care as doctors will not be seeing volumes of patients a day as they do now. The doctors aren't greedy, they are well deserved hard working people that deserve the right to choose whom they see based on payment in return.
    • reply
      by deep roots on Mar 15, 2012 at 06:24 AM in reply to Hannah
      What an amazing comment!!!! "Keep Living" and don't you DARE get sick and have to use anything else but what you think your money can buy.
      • reply
        by Anonymous on Mar 15, 2012 at 10:31 AM in reply to deep roots
        I don't expect you to take care of me.......
  • by Told you so on Mar 14, 2012 at 07:48 PM
    We knew this was going to happen. Docs don't take Medicaid. And with all the PRIVATE HOSPITALS popping up, nobody but illegals with vouchers are going to be treated. AIN'T THAT A KICK IN THE HEAD!
  • by Reagan Republican on Mar 14, 2012 at 04:30 PM
    I told you so
  • by Gerry on Mar 14, 2012 at 04:30 PM
    Government is the problem and it is going to get worse.....much worse
  • by Bring it.... Location: tally on Mar 14, 2012 at 02:58 PM
    Why will we have Medicaid when obamacare is there to fix everything at a cost of 900 billion...oops, my bad... 1.7 trillion?
  • by Gman Location: Tally on Mar 14, 2012 at 01:22 PM
    This is a NO BRAINER!!!! A privately insured citizen would have to PAY a larger amount at the ER versus their primary care doctor. Medicaid folks don't pay ANYTHING no matter where they seek care!!!! MAKE THEM START PAYING FOR OUT-OF-NETWORK CARE!!!!! IT WOULD STOP! FEE FOR SERVICES!!! Works on working folks, but not of folks getting something for nothing!
    • reply
      by Really on Mar 20, 2012 at 08:11 AM in reply to Gman
      I have Medicaid and I have to pay for my doctor visits. Learn what you are talking about before you post something. I have a job, I pay my taxes. Stupid people
      • reply
        by Anonymous on Mar 22, 2012 at 03:48 AM in reply to Really
        he stated ER visit
  • by Realist Location: Tally on Mar 14, 2012 at 12:30 PM
    If they would get fined for half of the cost of the ER visit and the prescription drugs they get issued when they visit the ER, the abuse would stop. The only time they are to go to the ER is in dire emergency. I blame the government for letting people feel "entitled" when they are not, and handing out freebies to those who abuse the system. I am privately insured, have copays and pay taxes on everything, guess I am too old now to have 4 more kids and sit back and reap benefits just because the government will rewards sorriness!
    • reply
      by i somewhat agree on Mar 14, 2012 at 06:12 PM in reply to Realist
      they wouldn't have to go to the ER if #1. medicaid would pay. when I was a student years back my son was on medicaid and they didn'pay his specialist so they refused to see him, it wasn't my fault and if there was a copay I would have paid it. #2. I was on medicaid while attending schol and whenever I has cold symptoms or other issues it would take me two weeks to get in with my PCP. If you've ever had a sinus infection, with the sinus pressure and headache and congestion you want relief within a couple of days not a couple of weeks. My insurance now is great but the price of prescription drugs is outrageous. Thank Walmart for the $4 dollar medications. P.S. I work in a doctor's office and I see more patients wanting samples than ever and they have good jobs and good insurance but that doesn't mae them Sorry or Lazy. They ust ned to educate people more and yes I do agree that if they go to the E.R. for simple cold symptoms they should pay a copay. I also think that there needs to be a reporting system for those doctors who never have openings for their medicaid patients.
      • reply
        by huh? on Mar 15, 2012 at 07:12 AM in reply to i somewhat agree
        In one sentence you stated the price of prescription drugs is outrageous, then you thank walmart for 4 dollar prescriptions? Is 4 dollars outrageous?
        • reply
          by Anonymous on Mar 17, 2012 at 06:38 PM in reply to huh?
          Not all prescription drugs are available through the $4.00 program. My 2 RXs cost over $1,000 per month. That's just the copayment. I'd say that's pretty outrageous. But the alternative is not very pleasant either.
      • reply
        by Anonymous on Mar 15, 2012 at 10:31 AM in reply to i somewhat agree
        government created this problem and now you want them to fix it?
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