Featured Articles: Healthcare Reform

Greater Demand for Primary Care Following ACA Medicaid Expansion?

Monday, August 17, 2015   (0 Comments)
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Steffani Bailey, PhD

Jennifer DeVoe, MD, DPhil


Oregon Health Sciences University Family Medicine and OCHIN together undertook a three-year study called “Community Health Center Use after Oregon’s Randomized Medicaid Experiment.” The results, explained below, suggest a possible increase in the demand for primary care service following ACA insurance expansion.


In the wake of Affordable Care Act (ACA) Medicaid expansion comes a debate as to whether or not community health centers (CHC) will experience increased demand for services. Many predict that ACA expansion will lead to higher demands in CHCs, while others postulate that individuals who gain insurance will seek care elsewhere. To better understand how use of CHC services might change, researchers from OHSU Family Medicine and OCHIN studied primary care use over a three-year period among a population of low-income adult CHC patients who gained coverage after Oregon expanded its Medicaid program in 2008 through the “Oregon Experiment”.


Researchers analyzed data on 34,849 patients, 13,219 of whom had recently obtained insurance coverage through Medicaid, and 21,630 of whom remained uninsured. Results of the analysis showed that Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals and imaging. Specifically, researchers found the number of primary care office visits per month was 282 per 1,000 Medicaid-covered patients, compared with 201 for patients without coverage.


Beyond primary care, Medicaid coverage also led to a 58 percent higher rate of referrals, 27 percent higher rate of laboratory tests, and a 33 percent higher diagnostic imaging rate. This increase in appropriate specialty care use is promising because it suggests that, as CHC patients gain insurance via the ACA, they will be able to access much-needed services that had been difficult to obtain while uninsured.


The findings of this study echo what many on the ground are already experiencing: ACA insurance expansion will lead to higher demand for services from CHCs and other primary care settings. Primary care is the first line of defense in managing – and preventing – disease, and it is especially critical to those who are newly insured and have previously experienced limited access to health care services. CHCs and other primary care clinics are already proving that increased access to care and continuity of care are improving patient outcomes. However, if primary care services are not able to grow at the same rate as new demands, patients who gain insurance coverage – and those who remain uninsured or under-insured – will see barriers to access.


If the United States health care system is not able to adequately provide primary care services, potential gains in population health might not be realized, and health care costs will increase unnecessarily as patients seek hospital care for primary care-treatable conditions. Thus, the authors assert that it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings.


The full article is available at Annals of Family Medicine:


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