Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study

  • Michael L. Barnett
  • Zirui Song
  • Sherri Rose
  • Asaf Bitton
  • Michael E. Chernew
  • Bruce E. Landon
Health Policy

DOI: 10.1007/s11606-017-4072-4

Cite this article as:
Barnett, M.L., Song, Z., Rose, S. et al. J GEN INTERN MED (2017). doi:10.1007/s11606-017-4072-4

Abstract

Background

Shopping for health insurance is encouraged as a way to find the most affordable coverage that best meets an enrollee’s needs. However, the extent to which individuals switch insurance and subsequent changes in health care utilization that might arise, particularly new physician visits, are not well understood.

Objective

To examine the relationship between insurance switching and new physician and emergency department visits around the time of a switch.

Design

Observational study using a difference-in-differences design to compare those switching insurance carriers with propensity score-matched controls who did not switch, stratified based on whether individuals initially had private or Medicaid insurance coverage. All analyses adjusted for individual and insurance characteristics.

Participants

Continuously insured, non-elderly individuals with private or Medicaid insurance coverage in Massachusetts from 2010 to 2013.

Main Measures

Rates of new primary care and specialist physician visits, as well as rates of emergency department visits.

Key Results

Before matching, among 1,628,057 continuously insured individuals, 418,231 (26%) switched insurance carriers during a 2-year period. Characteristics of switchers and non-switchers were similar after matching (n = 316,343 in each group). After matching, switching plans was associated with a 203% and 47.5% increase in the rate of new primary care physician visits following switching for those initially with Medicaid or private coverage, respectively (both p < 0.001), with a large short-term increase, diminishing over time. Among those with Medicaid coverage, switching was associated with a 14.9% higher rate of ED visits during the month of switching (p < 0.001), but otherwise decreased modestly after switching.

Conclusions

Insurance switching is common, and is associated with increased new physician visits and temporarily increased ED use among the publicly insured. As insurance markets become more volatile in the current policy environment, understanding changes in utilization after insurance switching may become increasingly important.

KEY WORDS

health insurance primary care utilization emergency department utilization insurance exchanges 

Supplementary material

11606_2017_4072_MOESM1_ESM.docx (798 kb)
ESM 1(DOCX 798 kb)

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Michael L. Barnett
    • 1
    • 2
  • Zirui Song
    • 3
    • 4
  • Sherri Rose
    • 3
  • Asaf Bitton
    • 2
    • 3
    • 5
  • Michael E. Chernew
    • 3
  • Bruce E. Landon
    • 3
    • 6
  1. 1.Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonUSA
  2. 2.Division of General Internal Medicine and Primary Care, Department of MedicineBrigham and Women’s HospitalBostonUSA
  3. 3.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  4. 4.Department of MedicineMassachusetts General HospitalBostonUSA
  5. 5.Ariadne Labs, Brigham and Women’s Hospital & Harvard T.H. Chan School of Public HealthBostonUSA
  6. 6.Division of General Medicine and Primary CareBeth Israel Deaconess Medical CenterBostonUSA

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