Cuts in 2003 to the Oregon Health Plan, Oregon's Medicaid expansion program, led to a 20 percent increase in emergency department visits by the uninsured. The cuts also led to a nearly 50 percent increase in hospital admissions of uninsured emergency patients. The study is published today in the online version of Annals of Emergency Medicine.
Researchers with the Oregon Health & Science University Center for Policy and Research in Emergency Medicine reviewed visits to Oregon emergency departments during the 24 months before and after the Oregon Health Plan (OHP) cuts in February and March 2003. While uninsured patients typically use the emergency department less than Medicaid patients, there was an abrupt and sustained rise in emergency department visits by the uninsured following the OHP cuts.
"While emergency hospitalizations for uninsured patients increased by 50 percent, rates for other groups remained about the same," said Robert A. Lowe, M.D., director of the OHSU Center for Policy and Research in Emergency Medicine. "This suggests that uninsured patients seeking care at emergency departments after the cuts were sicker."
At the same time, visits by uninsured psychiatric patients doubled. In addition, alcohol-related visits by uninsured patients rose by 82 percent and drug-related visits by uninsured patients rose by 173 percent. These increases are likely due to the concurrent cutbacks in mental health and drug treatment services by the Oregon Health Plan.
Overall, uncompensated care for Oregon hospitals rose from $256 million in 2002 (before the OHP cuts) to $509 million in 2004 (after the OHP cuts), according to research by the Office for Oregon Health Policy Research.
"As policymakers contemplate fundamental changes to Medicaid programs nationwide, these events in Oregon should provide a warning about a potential large increase in emergency department use by the uninsured in the United States," said Lowe, lead author of the study and associate professor of emergency medicine in the OHSU School of Medicine. "Cost-cutting measures may have substantial and lasting impacts on the health care system, and more importantly on its most vulnerable patients."
This project was supported by grants from the Office for Oregon Health Policy Research and the Robert Wood Johnson Foundation.
Oregon Health & Science University is the state's only health and research university, and Oregon's only academic health center. OHSU is Portland's largest employer and the fourth largest in Oregon (excluding government), with 12,400 employees. OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.