Medicaid HMO Enrollees in the Emergency Room: Use of Nonemergency Care

Abstract

Medicaid managed care is generally acknowledged to reduce the use of emergency departments (EDs). Yet some studies of Medicaid managed care have shown no change in ED use, and others show wide variation across plans. Because emergency departments may not be the best place to deliver nonemergency care, it is useful to understand the characteristics of enrollees associated with a lower likelihood of ED use for nonurgent conditions. A recent study of Medicaid enrollees in a large Colorado health maintenance organization (HMO) revealed several sociological and psychological factors associated with nonemergency ED visits. The study found that nonemergency visits by people who are female, older, more satisfied with the HMO and their doctor, and enrolled longer in the HMO are less likely to visit the ED, whereas visits on weekends and those by people who live farther from their physicians and people who have more inpatient hospital admissions are more likely to be to the ED.