The first study, led by research investigator Kevin Dombkowski, Dr.P.H., analyzed state Medicaid claims data from 2000, when most Medicaid beneficiaries were enrolled in managed care plans. Two companion studies, led by pediatric emergency medicine specialist Rachel M. Stanley, M.D., were based on interviews with 422 adults who accompanied children on visits to 13 Michigan ERs for low-urgency complaints; about half of the kids were covered by Medicaid.
Dombkowski's analysis of Medicaid claims found that 21 percent of children enrolled in Medicaid visited the ER at least once during the year 2000, and about 75 percent of their ER visits were for non-emergent problems.
Dombkowski then looked at the childrens Medicaid enrollment patterns, finding that 60 percent of children were enrolled in a Medicaid managed care plan for the entire year. The other 40 percent had some months of coverage under the traditional fee-for-service Medicaid structure, either because there was no managed-care Medicaid plan open in their area or because they were newly qualified for Medicaid and were awaiting plan enrollment.
By comparing ER visit rates among children enrolled in fee-for-service Medicaid and those in managed care, Dombkowski made an interesting discovery. "Kids who spent all of 2000 in fee-for-service Medicaid used the ER for non-emergent care 22 percent more often than children who had managed-care coverage the entire year," he explains. "Even those enrolled in fee-for-service for only part of 2000 came to ERs for emergent care 26 percent more often than those in managed care plans.""
The causes behind these trends become clearer with Stanley's research, which gathered information directly and anonymously from the 422 adults who brought children to 13 ERs throughout the state in 2001. All of the children had been triaged by ER staff as low-urgency cases, and all were over 6 months of age, to screen out nervous parents of newb
Contact: Kara Gavin
University of Michigan Health System