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Impact of Medicaid disenrollment on health care use and cost
Mary E Rimsza1, Richard J Butler, William G Johnson
1Center for Health Information and Research, School of Computing and Informatics, Ira A. Fulton School of Engineering, Arizona State University, PO Box 874711, Tempe, AZ 85287-4711, USA. mrimsza@asu.edu
Insights
Losing public health insurance increases emergency room visits and hospital stays for children, raising community healthcare costs significantly. This shift from outpatient to emergency care strains resources and exacerbates existing shortages.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Health Policy
Background:
- Children covered by public insurance and uninsured children represent significant populations in urban areas.
- Understanding healthcare utilization patterns is crucial for resource allocation and policy development.
Purpose of the Study:
- To compare healthcare use between publicly insured and uninsured children in a major urban setting.
- To assess the impact of disenrollment from public insurance on children's healthcare access and community costs.
Main Methods:
- Analysis of 2004 healthcare transactions for over 212,000 children in the Phoenix metropolitan area.
- Utilized a community-wide administrative health database (Arizona HealthQuery).
- Employed a multivariate model to examine the effect of a hypothetical 10% disenrollment from Medicaid/State Children's Health Insurance Program.
Main Results:
- A 10% disenrollment would increase annual community healthcare costs by over $3.46 million.
- Each disenrolled child would incur an additional $2121 in healthcare costs.
- Disenrollment drives a shift to more expensive emergency department care and increases hospital days.
Conclusions:
- Programmatic disenrollment from public insurance increases emergency department visits and hospitalizations.
- These changes lead to higher overall community healthcare expenditures.
- Loss of public insurance coverage shifts care to more costly settings, worsening ED overcrowding and bed shortages.
Objective:
The objective of this study was to compare the health care use of children who are covered by public insurance and uninsured children who live in a large urban area and the potential impact of disenrollment on health care use and costs if these children become uninsured.
Methods:
The 2004 health care transactions for 43,313 uninsured children and 168,722 children who were insured by Medicaid/State Children's Health Insurance Program and living in the Phoenix metropolitan area were analyzed using a community-wide administrative health database (Arizona HealthQuery). Using a multivariate model of health care use by currently uninsured children, we examined the effect of 10% disenrollment of the children who were currently insured by Medicaid/State Children's Health Insurance Program.
Results:
A 10% disenrollment would increase the costs of health care in the community by $3,460,398 annually, or $2121 for each child disenrolled. This increase in costs is attributed to a shift of care from ambulatory settings to more expensive emergency departments and an increase in hospital days. We determined that 69% of the change in emergency department visits, 58% of the change in hospital stays, and 74% of the change in ambulatory visits would be attributable to the change in insurance status.
Conclusions:
Programmatic changes that result in disenrollment from public insurance programs will increase the number of emergency department visits and hospital days as well as the total community costs of health care. These increases in health care use can be expected to aggravate community problems of emergency department overcrowding and inpatient bed shortages. The majority of the changes in use are attributable to changes in insurance status, which results in a shift of care from less expensive ambulatory settings to emergency departments and increases in hospital days when children lose Medicaid/State Children's Health Insurance Program coverage.
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