People with private health insurance coverage have better accessto primary care providers than do their counterparts who arecovered by Medicaid and Medicare.

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But the generally accepted notion that the latter patientsfrequently go to emergency rooms for non-emergency treatment due toa lack of understanding about receiving treatment simply isn'ttrue. Easier access, not “differences in patient-perceived acuityfor patients covered by Medicaid [and Medicare] insurance,” isresponsible for this well-documented trend.

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So say University of Colorado School of Medicine researchers whocrunched data on 4,606 patients gathered during the 2011 NationalHealth Interview Survey.

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The researchers dug into the data to look for evidence thatsupported the notion that Medicaid and Medicare patients simplydon't know enough about the health care delivery system to seek outprimary care services rather than running to the emergency room ofthe local hospital for routine care.

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What they found was that the Medicaid/Medicare patients couldnot get a hold of a primary care practitioner when they neededroutine human body maintenance. Either they didn't get responses totheir attempts to set up appointments, or they faced such a narrowrange of treatment options that a visit to the ER was the onlylogical choice.

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The researchers looked at data for two categories of patients:“those who used the emergency department because they felt theyneeded to get immediate medical care [i.e. true emergencies] andthose who used the emergency department because they had troubleaccessing care elsewhere.”

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Here's what they reported:

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“Relative to those with private insurance, adults with Medicaidand Medicare were similarly likely to seek emergency care due to anacuity issue. Adults with Medicaid and those with Medicaid andMedicare (i.e., dual eligible) were more likely than those withprivate insurance to seek emergency care because of access issues.Reasons for seeking care in an emergency department by healthinsurance type may be driven more by lack of access to alternatecare, rather than by differences in patient-perceived acuity forpatients covered by Medicaid insurance.”

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Culling the data, the researchers said that Medicaidbeneficiaries in particular “often mention the inability to get ahold of their primary care providers, get a return phone call or asame day appointment when needed.”

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“There is a misconception that patients with Medicaid insuranceare more likely to use emergency rooms for a non-urgent issue whencompared with those who have private insurance,” said Dr. RobertaCapp, who led the study. “Medicine is complex and patients, nomatter what insurance they have, are not always able to determinewhat is urgent or not urgent.”

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Researchers recommended that health care policymakers “shouldfocus on increasing timely access to primary care, especially forMedicaid beneficiaries. Improved care coordination between patientsand emergency providers is also necessary to reduce emergencydepartment utilization. With the implementation of the AffordableCare Act, millions of new patients will be enrolled in Medicaid andadded to an already overburdened primary care system.”

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.