Too often in life, we have a problem. So in order to solve the problem and improve the situation we focus on the output and apply our solution. Take, for example, the Medicaid expansion outlined in the Affordable Care Act (a.k.a. ObamaCare).
It’s a simple premise – by expanding Medicaid (i.e. giving people health insurance), customers will go to the doctor more and Emergency Department visits will be reduced. However, as noted in the Wall Street Journal, a new study of 10,000 low-income Oregon residents found this not to be the case.
There are a couple of issues at play here. The first is that the healthcare delivery system is not structured to accommodate this usage. When the number of insured was increased, did the delivery system change? Were clinics opened in low-income areas, where the population resides or works to accommodate them? Were doctor’s office hours changed? Were consumers notified of how to get appropriate care? Of course, the answer is No.
The second issue is that of consumer behavior. If you give someone a benefit with the hopes of changing behavior, but do not change the way the benefit can be used, the person will use it within the confines of the current system. Then behaviors will not change.
Some may say the newly insured should use physician offices and clinics that exist, but if none are nearby, or can fit them in, then they have no choice but to go to the ER. If they do have a job, it is likely not one they can easily take off work to take care of a non-emergent issue for himself or herself or a loved one. Additionally, where they work may not be near where they live, so access to a clinic or physician office that will take Medicaid may be limited by either the location of the facility or their ability to get there (for example, if they take public transportation to get to work). Unfortunately, it is easier to go after work or school, which means most clinics / MD offices are closed, so what other option exists? The ER.
The system is not set up to support he benefit, so the consumer will use the only avenue available.
So, what does this mean?
For providers, it can actually be a revenue enhancement opportunity as people who were once uninsured, now have insurance. However, under the current system, this will mean an increase in the number of Emergency Department visits. Hospital administrators need to make sure systems are in place to manage this influx so as to not increase the Average Length of Stay (ALOS) in the ED (which some would say is too high already). It also creates the opportunity to serve those in currently under-served areas by opening clinics and physician offices in thee areas and communicating to the consumers the availability and when to go where (Clinic vs. ED).
Consumers also have a responsibility to educate themselves and make appropriate changes as the system changes. The challenge is, changing consumer behavior can take time.
Challenges and Problems like this can be solved, but only if the focus of the solution is on analyzing and improving the entire system and not just the output.