Visits to ER rise despite health law

Study author says issue is complex

By Chelsea Conaboy
Globe Staff / June 7, 2011

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Emergency room visits have been on the rise in Massachusetts since the passage of the 2006 health care law, much to the chagrin of supporters who projected that the opposite would happen as more people had insurance and were connected with primary care providers.

A new study published online shows that the issue may be a bit more nuanced.

While overall emergency room visits increased about 4.1 percent between 2006 and 2008, visits for “low severity’’ problems fell slightly, by 1.8 percent, among patients who are poor or uninsured, according to the study posted last month by the Annals of Emergency Medicine.

The decline is a small step in the right direction, but it also provides a reality check, said the lead author, Dr. Peter Smulowitz, an emergency physician at Beth Israel Deaconess Medical Center.

Smulowitz said the 2006 law has done what it was designed to do, expand health insurance, but its success has been unfairly measured by emergency room usage.

The idea that the law has failed if it has not reduced those visits is “nonsensical,’’ he said.

The reasons why people go to an emergency room versus a primary care doctor are complex and subject to social conditions and people’s perceptions of the seriousness of their problem, Smulowitz explained. The unavailability of most primary care physicians during off hours and on short notice is also a major driver.

The finding that even for more minor issues like strep throat and sprained ankles, few people with insurance are bypassing the emergency room in favor of a primary care office should “dispel the notion that providing health insurance will suddenly make [emergency departments] obsolete,’’ he said.

The researchers looked at billing data for about 578,000 emergency room visits to 11 hospitals during the year before the law took effect in 2006 and two years afterward.

MIT economist Jonathan Gruber, who helped legislators draft the law, said some people who avoided emergency rooms because they were too expensive in the earlier period may be using them more, now that they have coverage, offsetting the progress of moving some people into primary care practices.

He said more work is needed to deter people from using the emergency room for problems that are not urgent, through charging higher copayments or developing programs that target chronic users.

“I think the lesson here is you don’t save as much on emergency rooms as you’d think from universal coverage,’’ he said. “It’s not clear why.’’

Chelsea Conaboy can be reached at