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Insurance instability and use of emergency and office-based care after gaining coverage: An observational cohort study

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  • Paul R Shafer
  • Stacie B Dusetzina
  • Lindsay M Sabik
  • Timothy F Platts-Mills
  • Sally C Stearns
  • Justin G Trogdon

Abstract

Background: The Affordable Care Act led to improvements in reporting a usual source of care, but it is unclear whether patients are changing their usual source of care in response to coverage gains. We assess whether prior insurance instability is associated with changes in use of emergency and office-based care after the Marketplace and Medicaid expansion were introduced. Methods: Our study draws from the 2013–14 Medical Expenditure Panel Survey, identifying a cohort of non-elderly adults with full-year health insurance coverage in 2014. We use linear and multinomial logistic regression to assess the relationship between insurance instability prior to 2014 (uninsured for 1–11 months, ≥12 months) and person-level changes in use of health care after gaining coverage (change in ED and office visits from 2013 to 2014) with continuously insured individuals serving as a comparison group. Results: Being uninsured for at least one year prior to gaining full-year coverage in 2014 was associated with a 33% increase in ED visits (0.06 visits, p

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  • Paul R Shafer & Stacie B Dusetzina & Lindsay M Sabik & Timothy F Platts-Mills & Sally C Stearns & Justin G Trogdon, 2020. "Insurance instability and use of emergency and office-based care after gaining coverage: An observational cohort study," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-12, September.
    • Handle: RePEc:plo:pone00:0238100
    DOI: 10.1371/journal.pone.0238100
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    1. Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
    2. Amanda E. Kowalski, 2018. "Extrapolation using Selection and Moral Hazard Heterogeneity from within the Oregon Health Insurance Experiment," Cowles Foundation Discussion Papers 2135, Cowles Foundation for Research in Economics, Yale University.
    3. Michael L. Anderson & Carlos Dobkin & Tal Gross, 2014. "The Effect of Health Insurance on Emergency Department Visits: Evidence from an Age-Based Eligibility Threshold," The Review of Economics and Statistics, MIT Press, vol. 96(1), pages 189-195, March.
    4. Courtemanche, Charles & Marton, James & Ukert, Benjamin & Yelowitz, Aaron & Zapata, Daniela, 2018. "Effects of the Affordable Care Act on Health Behaviors after Three Years," IZA Discussion Papers 11468, Institute of Labor Economics (IZA).
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