Emergency department use by adult medicaid patients after implementation of managed care.
OBJECTIVE
To determine whether the advent of a mandatory Medicaid managed care (MMC) plan had any effect on emergency department (ED) utilization by adult Medicaid patients at an urban teaching hospital.


METHODS
This was a retrospective cohort study using four years of ED records encompassing the year prior to initiation of MMC (1994-95), the enrollment year (1995-96), and two years after the program had matured (1996-98).


RESULTS
Total ED census declined slightly, then returned to 1995 levels. Emergency department use by MMC patients declined steadily, with the 1998 figure of 5,888 representing a 40% decline over the pre-MMC volume of 9,849. Visits by MMC patients with acute illness or injury declined by 29%; MMC low-acuity visits decreased by 43%. Medicaid managed care low-acuity after-hours/weekend visits declined by 19%, then leveled off. The MMC enrollment was stable throughout the study period.


CONCLUSIONS
Mandatory managed care can be associated with considerable diminution in ED use by Medicaid patients. This decline is most pronounced in low-acuity triage categories, and least evident after hours and on weekends.
Powers
R D
RD
University of Connecticut School of Medicine, Farmington, CT, USA. rpowers@harthosp.org
D000328:Adult; D003237:Connecticut; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008329:Managed Care Programs; D008484:Medicaid; D012189:Retrospective Studies; D014218:Triage; D014481:United States; D014600:Utilization Review