Some Oregonians thought reductions in Oregon Health Plan (OHP) services and increases in patients' out-of-pocket expenses would send a flood of patients to hospital emergency departments (EDs) for care they used to receive elsewhere. A short-term study by emergency medicine faculty at Oregon Health & Science University indicates there was a significant increase in uninsured patients and a decrease in ED use by OHP patients at OHSU Hospital's ED following those changes.
Changes to the OHP included the elimination of outpatient behavioral health and chemical dependency coverage and an increase in patient's out-of-pocket expenses for premiums and co-payments.
"In the setting of recent, significant cutbacks in the Oregon Health Plan and rising unemployment, the dramatic changes in ED use that we found make me fear that access to medical care for Oregonians is deteriorating," said
Robert A. Lowe, M.D., M.P.H., principal investigator in the study and director of OHSU's Center for Policy and Research in Emergency Medicine.
The study compared the information from patients treated at OHSU Hospital's ED from March to May 2002 with patients seen in those same months during 2003. Investigators assessed each patient's insurance coverage, and the type of care he orshe required. Specifically the team looked at ED visits for mental health, alcohol, chemical dependency, problems that could have been treated by a primary care clinic and emergencies that could have been prevented with earlier access to primary care.
Lowe's team found the following:
- A 17 percent increase in patients without insurance.
- A 20 percent reduction in OHP patients.
- A 136 percent increase in alcohol-related visits by patients without insurance.
- A 200 percent increase in chemical dependency visits by patients without insurance.
- A 37 percent increase in other mental health visits by patients without insurance.
The study was not designed to indicate what might have caused these changes, but Lowe believes these preliminary numbers are valuable. The study concludes that the increase in ED visits by patients without insurance could be due to many things simultaneously -- OHP cutbacks, loss of commercial health insurance because of unemployment and/or decreased availability of health care providers caring for uninsured patients.
"We don't fully understand the causes of these changes. However, it may be a greater risk to the health of Oregonians if we wait for further research before making changes to the health care policy," said Lowe. "We hope this very preliminary study will be useful information to policy-makers in Oregon and in other states facing similar decisions."
Concerns by the Office for Oregon Health Policy & Research (OHPR) led them to form the Oregon Health Research and Evaluation Collaborative (OHREC), a statewide organization that includes health services researchers from Oregon's distinguished universities, state and local agencies. OHREC and OHSU's CPR-EM embarked on a preliminary study looking at the impact cutbacks have on OHP patient's access to health care.
OHPR, through grant dollars awarded by the Robert Wood Johnson Foundation State Coverage Initiative, funded this study. The funding for this study will allow Lowe to examine OHSU's ED data over a year's time. Lowe's team is actively pursuing funding sources to expand the study to other EDs around Oregon so that the picture will be more comprehensive.
Individual patient stories demonstrate the harse reality that many vulnerable Oregonians face. The study cites as an example :
A six-year-old boy who had stuck himself with the discarded "works" - the needle used by a drug user - which he found while playing on the grounds outside a church. His mother delayed bringing him to the ED for several days because she was trying to find a primary care provider who would take her son's OHP card. (By the time he came to the ED, it was too late to provide preventive treatment against HIV infection.)
Lowe will be presenting his findings at the next OHREC public meeting this fall. For more information please, contact OHPR's Portland office at (503) 731-3005 ext.355 or http://www.ohpr.state.us/. Lowe and his team look forward to working with policy-makers to continue to investigate the state of Oregonians' health and find ways to improve access.
BACKGROUND:
OHSU'S CENTER FOR POLICY AND RESEARCH IN EMERGENCY MEDICINE - This unique center was formally established in April 2003 to coordinate emergency medicine research projects that can help guide health care policy. It is the only one of its kind in an academic Department of Emergency Medicine. It features four full-time faculty members with diverse backgrounds in medicine, public health, epidemiology, economics and statistics. The center also is part of the Oregon Health Policy Institute which includes faculty from OHSU, Portland State University and Oregon State University. OHSU's Center for Policy and Research in Emergency Medicine currently has 15 studies underway looking at ways to improve the way we deliver emergency care.
OFFICE FOR OREGON HEALTH POLICY & RESEARCH - This state office provides oversight and coordination for all elements of the Oregon Health Plan and technical and policy support to legislative and executive decision-making. The Administrator reports directly to the Governor and Legislature. OHPPR's nine professional and five office staff conduct qualitative and quantitative research and policy analysis, support the work of three research/policy bodies (Oregon Health Council, Health Resources Commission, and Health Services Commission), and staff special committees (Genetic Research Advisory Committee, Advisory Committee on Physician Credentialing Information, and Oversight Task Force on Mental Health Integration).
OREGON HEALTH RESEARCH & EVALUATION COLLABORATIVE - This unique collaborative of Oregon health services researchers, state agencies, stakeholders and advocates was formed to share information and to study the impact of changes to the Oregon Health Plan. OHREC is designed to facilitate communication of research findings to policymakers, both statewide and nationally. Initial funding for the formation of the collaborative has been through Oregon's Robert Wood Johnson State Coverage Initiatives Grant through the Office of Oregon Health Policy and Research.