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Emergency room use and primary care case management: Evidence from four medicaid demonstration programs

Author

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  • Hurley, R.E.
  • Freund, D.A.
  • Taylor, D.E.

Abstract

Claims-based utilization data collected in four Medicaid demonstration programs are used to examine the impact of primary care case management on patterns of reliance on the emergency room as a source of services. The experience of stratified random samples of AFDC (Aid to Families with Dependent Children) adults and children in the demonstration programs is compared with that of equivalent samples from comparison groups in traditional Medicaid programs. Data were analyzed in multivariate models controlling for person characteristics in a pre/post, demonstration/comparison design. Results indicated large reductions in the proportion of persons with at least one emergency room visit ranging from 27 to 37 per cent for children and 30 to 45 per cent for adults. Use levels for persons with at least one ER visit are less substantially affected. The findings suggest that gatekeeping designs can alter patterns of enrollee use with respect to the emergency room and some discussion of these implications is presented.

Suggested Citation

  • Hurley, R.E. & Freund, D.A. & Taylor, D.E., 1989. "Emergency room use and primary care case management: Evidence from four medicaid demonstration programs," American Journal of Public Health, American Public Health Association, vol. 79(7), pages 843-846.
    • Handle: RePEc:aph:ajpbhl:1989:79:7:843-846_8
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    Cited by:

    1. Robert Kaestner & Lisa Dubay & Genevieve Kenney, 2002. "Medicaid Managed Care and Infant Health: A National Evaluation," NBER Working Papers 8936, National Bureau of Economic Research, Inc.
    2. Freund, D.A. & Kniesner, T.J. & LoSasso, A.T., 1996. "How Managed Care Affects Medicaid Utilization : A Synthetic Difference-in-Difference Zero-Inflated Count Model," Discussion Paper 1996-40, Tilburg University, Center for Economic Research.
    3. R. Riportella-Muller, "undated". "Using a Model to Evaluate the Impact of Managed Care on Medicaid-Eligible Moms and Their Children in a Rural Population," Institute for Research on Poverty Discussion Papers 1155-98, University of Wisconsin Institute for Research on Poverty.
    4. Gearhart Richard, 2019. "The Impact of Secondary Environmental Variables on OECD Healthcare Efficiency: A Robust Conditional Approach," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 19(2), pages 1-16, April.
    5. Roberts, Emilie & Mays, Nicholas, 1998. "Can primary care and community-based models of emergency care substitute for the hospital accident and emergency (A & E) department?," Health Policy, Elsevier, vol. 44(3), pages 191-214, June.
    6. Burkey, M.L. & Bhadury, J. & Eiselt, H.A., 2012. "A location-based comparison of health care services in four U.S. states with efficiency and equity," Socio-Economic Planning Sciences, Elsevier, vol. 46(2), pages 157-163.

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