MADISON — Expanded public health insurance coverage increases access to outpatient care and markedly reduces hospitalizations, new research by University of Wisconsin-Madison researchers find. Dr. Thomas DeLeire, director of the La Follette School of Public Affairs, and colleagues from the UW Population Health Institute looked at Wisconsin’s 4-year-old public insurance program – the BadgerCare Plus Core Plan – for childless adults with incomes up to 200 percent of the federal poverty level.
They compared claims data from 9,619 adults, all from Milwaukee County, from the year before they were automatically enrolled in January 2009, to their first year with health insurance coverage. The enrollees were “very low- income childless adults with markedly high prevalence of chronic illness;” more than a third of them had two or more types of chronic disease, including high blood pressure, heart problems, diabetes, depression and alcohol and drug abuse.
The authors found that after 12 months in the program, participants showed a 29 percent increase in outpatient visits, a 46 percent increase in emergency department use, and a 59 percent decrease in hospitalizations, including a 46 percent decline for preventable hospitalizations.
“These results demonstrate that expanding public insurance coverage has the potential to increase access to outpatient care and reduce hospitalizations,” DeLeire says. “In addition, we find that unless consumers have sufficient access to primary care, coverage expansions may also increase in emergency department visits, shrinking any corresponding cost savings.”
As a result of the provisions of the federal Affordable Care Act, states are expanding or considering expanding Medicaid coverage to low-income adults without dependent children.
“Our results speak directly to the potential of these expansions to improve health and to reduce costs by increasing access to outpatient care and reducing hospitalizations,” DeLeire says. “They also suggest that states need to prepare for the possibility of a large increase in the demand for outpatient services.”
DeLeire’s co-authors include Laura Dague, assistant professor at the Bush School of Government and Public Service at Texas A&M University; Lindsey Leininger, assistant professor in the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago; and Kristen Voskuil and Donna Friedsam, both researchers at the UW Population Health Institute, where Friedsam is also health policy programs director. The research was funded by the Wisconsin Department of Health Services and is being published in the June issue of the journal Health Affairs.