Research to date has documented the overutilization of the emergency room by Medicaid recipients for relatively non-urgent conditions, and the potential tradeoffs between ER utilization and access to primary care services such as office-based physician services and efficacious prescription drug therapy. The objective of this research was to delineate the effect that a limitation on the availability of prescription drugs secondary to a change in program policy would have on the likelihood of experiencing an ER episode. Utilizing the framework proposed by Andersen and Newman, a retrospective analysis of data from the Georgia Medicaid Program was conducted. Data elements of interest included emergency room episodes, prescription drug utilization, demographic information, and other measures of medical care utilization such as inpatient hospitalization and ambulatory physician episodes. Aggregate results revealed a high rate of ER utilization at lower average levels of prescription use in the continuously eligible population. Within a group of recipients with at least one ER episode in a given year, prescription drug users at the prescription constraint were found to have higher rates of ER use, on average, than recipients not at the prescription constraint. The patient-level analysis results concurred with the population results relative to the change in policy, where recipients at the prescription constraint had a higher relative risk of experiencing an ER episode. These results suggest the presence of a small but significant prescription constraint effect on the subsequent utilization of emergency room services in a sample of medicaid recipients. Relevant policy issues are discussed.
Learning Objectives: 1. Paricipants will be able to summarize the research to date on emergency room utilization by Medicaid recipients and the factors that have been implicated in the same. 2. Participants will learn about current research into the relationship between discretionary ER use by Medicaid recipients and the availability/accessibility of primary care services in their area of residence. 3. Participants will learn more about the potential relationship between emergency room utilization and the presence of a utilization constraint on prescription drugs in a sample of Medicaid recipients
Keywords: Medicaid, Policy/Policy Development
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: N/A
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.