Oregon: Statewide Decline in ED Visits

From the Medford (OR) News:

Cutbacks in the Oregon Health Plan (OHP) including establishment of a $50 co-payment for Emergency Department (ED) visits led to a 14 percent drop in ED use among OHP Standard enrollees, according to Oregon Health & Science University (OHSU) study results presented this week in Washington, D.C., at the American College of Emergency Physicians Research Forum.

"Our first reaction to the results was excitement at the cost savings from reduced ED use, but when we put these findings in context, the news was not so good," said lead investigator Robert A. Lowe, M.D., M.P.H., director of the OHSU Center for Policy and Research in Emergency Medicine and associate professor of Emergency Medicine in the OHSU School of Medicine. "Absent improved safety net access outside the ED, it is likely that these patients did without care, rather than getting less expensive care."

The study found that enrollees in OHP Standard used the ED 14 percent less after they became subject to the co-payments in March 2003, while enrollees in OHP Plus, who were not affected by the co-payments and other cutbacks, demonstrated no change in ED use.

"ED use is often a barometer of the status of our health care system," said Lowe. "Identifying ED trends helps us to understand when health care access issues may be facing a crisis point."

"This study's results raise timely questions," said Charles A. Gallia, Ph.D., evaluation research coordinator for OMAP, and study co-author. "For instance, did the benefit reduction and increased co-pays have the unintended consequence of suppressing use of some preventive health care services, even those that would best be treated in an ED setting, thereby making the long-term costs even higher?"