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Are the newly insured clogging the system?

We are starting to get some insight into how 10 million (plus or minus a couple million) newly-insured people will affect the health care delivery system.

For years, we’ve been speculating about the impact of coverage expansion on care – Will the new influx of folks onto the rolls of the insured increase waiting times?  Will they clog up emergency rooms, labs, doctors’ offices and surgery centers? Will it be impossible to get into a primary care facility?

Briefly, tighter supply early on, less so in the future as pent-up demand eases up.

Here are the details…

Using data from California’s Low Income Health Plan (LIHP), the Oregon Health Insurance Experiment and other studies, researcher Gerald Kominski and his colleagues assessed how the newly-insured use health care services, how that changes over time, and the impact on the health care delivery system.

The net is this –

“We see an increase in utilization in the first year, and especially in the first few months,” Kominski told California Healthline. “But then there’s a dramatic drop-off…this a temporary, not permanent phenomenon.”

There’s latent demand for health care services as those previously un-insured get those nagging health issues checked out and addressed, then things settle down. This makes sense; while there may well be a small population that has ongoing chronic issues, most will be pretty healthy.

Notably, the Oregon study appeared to indicate the population continued to use ER services at a relatively high rate; speaking to this Kominski was quoted saying: “the Oregon study, in a sense, has been the outlier. It calls into question some other studies, because it doesn’t show across-the-board positive benefits.”

That’s good; we need more research into the impact of increased enrollment on the health care delivery system, and different results will encourage deeper dives into the data.

What does this mean for you?

So far, access to health care hasn’t been too big a problem.  There appears to be more demand initially due to coverage expansion, and there will be somewhat more demand over time.

And we would do well to continue to monitor access data such as appointment times.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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