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James Kirby AHRQ

Community Uninsurance Rates and Expenditures on Emergency Room Care: Is there Evidence of a Spillover?. James Kirby AHRQ. What is “Spillover”?. The number of uninsured people in a community may affect medical care for everyone, even those with health insurance. Why Might Spillover Occur?.

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James Kirby AHRQ

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  1. Community Uninsurance Rates and Expenditures on Emergency Room Care: Is there Evidence of a Spillover? James Kirby AHRQ

  2. What is “Spillover”? • The number of uninsured people in a community may affect medical care for everyone, even those with health insurance

  3. Why Might Spillover Occur? • A large number of uninsured residents may: • provide a less stable revenue base for providers • result in high levels of uncompensated care

  4. Literature • Previous literature focuses on access • Spillover to cost is not examined • Spillover in the context of emergency rooms is not examined

  5. Research Questions • Do insured individuals living in areas with many uninsured people pay more for emergency room care? • How does this differ by insurance type?

  6. Data Sources • Individual-level data: Medical Expenditure Panel Survey, 2009 • Adults with at least one emergency room visit who live in a county with 65,000 residents or more (N=3,773) • County-level data: American Community Survey, 2009

  7. Main Variables • Main Outcome variable • Average expenditure per emergency room visit • Main Independent variables • County-level: Number of uninsured individuals per emergency room • Individual-level: Insurance status

  8. Control Variables Individual-level County-level Poverty rate Unemployment rate Number of Federally Qualified Health Centers (FQHC) per capita MSA vs non-MSA • Race/ethnicity • Sex • Age • Subjective health • Serious chronic conditions • Poverty status

  9. Methods • Generalized Linear Model • Family: Gamma • Link: Log • Marginal predictions in dollars

  10. Means of Main Variables

  11. Marginal Predictions for Per-Visit Emergency Room Expenditure, All Adults

  12. Marginal Predictions for Per-Visit Emergency Room Expenditure, All Adults

  13. Marginal Predictions for Per-visit Emergency Room Expenditure

  14. Summary & Conclusion • The number of uninsured people per ED in a county is positively associated with average expenditures per ED visit • This association exists only among insured individuals • The association is strongest among those with public insurance • Reducing the number of uninsured people in communities may lower ED expenditures for the insured, but especially for those with public insurance

  15. Limitations • Unobserved differences in intensity of use? • Unobserved differences in county characteristics?

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