Increasing Prevention and Avoiding the ER

In 2012, the U.S. Census Bureau reported that the average life expectancy for black males is approximately 64 years old, compared with 73 years for white males. Racial and ethnic minority groups are less likely to have access to the preventive care they need to stay and are more likely than white Americans to suffer from chronic conditions, prompting the theme for this year’s Minority Health Month; “Prevention is Power: Taking Action for Health Equity.”

Luckily, 10.2 million Latinos, 6.8 million African Americans, nearly 2 million Asian and Pacific Islanders, and over a half million American Indians and Alaska natives will have the opportunity to receive health coverage thanks to the Affordable Care Act.

But – does acquiring health insurance mean that minorities will be more likely to access much-needed preventive care?

Typical scene at a local emergency room

A recent study in the journal Science compared thousands of Portland citizens who recently obtained health coverage through Medicaid versus those who remained uninsured, and found that people with health insurance made 40% more trips to the emergency room during the first 18 months that they were covered. Emergency room visits are precisely the trend that we want to reverse by increasing access to preventive care.

This study made me ponder the reasons why recently insured people may go directly to the emergency room:

  • Perhaps they were already suffering from chronic/untreated conditions and rushed to the emergency room as soon as they received coverage?
  • Maybe, after years of ER visits, people who used to be uninsured don’t automatically think to visit primary care doctors, but rather turn to the medical care option that they are familiar with?
  • Could it be difficult for this population to schedule preventive visits with primary care physicians?

This last question stuck with me. We know that due to the thinning out of primary care physicians and skyrocketing numbers of specialists, the U.S. is currently short 16,000 primary care doctors. This is understandable from the perspective of medical students – why be a general practitioner when you can make so much more money as a specialist and pay off those hefty student loans faster? However, it is discouraging to realize that 1 in 5 Americans live in Health Professional Shortage Areas throughout the country.

In order to prevent these doctors from turning too many new patients away, the Affordable Care Act has authorized a 10 percent bonus to primary care physicians who offer services to Medicare patients through 2015. This is a great incentive, but the question remains of whether these doctors will have the capacity to meet an increased demand for preventive visits.

Consider the lack of doctors, and factor in the likelihood that many of the existing primary care physicians still need training in culturally and linguistically appropriate services as pointed out in last week’s WellPower blog post, and it would be easy to understand why minority groups aren’t accessing preventive care.

One thing is for certain – we need to continue working with recently insured populations to ensure that they know that they are eligible for low-cost or no-cost annual check-ups through the Affordable Care Act, and help connect them with existing primary care doctors.

Why do you think recently insured people are going directly to the ER, and how can we refocus efforts on preventive care? Please comment below and let us know.

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I have extensive experience coordinating communications and outreach initiatives focused on health and social issues. In my current position as Project Specialist, I provide communications technical assistance to regional and federal efforts within the National Partnership for Action initiative, with support from the Office of Minority Health. I am a former Peace Corps volunteer who worked on health and social affairs projects in the Federated States of Micronesia. Read more.