ED visits rising in Oregon despite insurance plan

Lake Oswego, OR-The state's highly touted health insurance program for the working poor and uninsured has effectively reduced hospital emergency department (ED) visits. But some emergency physicians say ED visits may be on the upswing again. The reason, according to health officials, may be that some health plans are protecting their capitation budgets by applying tougher approval standards for patients seeking primary care services.

The increases in ED visits have been gradual but noticeable, according to one provider. "At first, there was a definite reduction. The program created attractive financial incentives for primary care physicians. But in the recent past we've seen a reversal of that trend," says John C. Moorhead, MD, professor of emergency medicine at Oregon Health Sciences University in Portland.

Since its inception in 1994, the Oregon Health Plan has won national recognition for covering thousands of uninsured residents for basic medical care, including hospital services. The program, which is funded biennially at $2.77 billion in state and federal funding, has reduced the rolls of the uninsured statewide to 17% of the population from 30% It provides coverage to some 200,000 individuals, according to state figures.

"Overall, hospitals continue to see reductions in ED visits and a reduction of about 10% in overall health care utilization. We're quite pleased with the results," says Ed Patterson, vice president of government relations with the Oregon Association of Hospitals and Health Systems in Lake Oswego.

Patterson acknowledged that some of the 17 insurance carriers that contract with the state have denied coverage and disallowed payments to providers to control costs. Last year, lawmakers enacted legislation curbing such practices.