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ED Mental Health Visits Increase for Young Adults After ACA Adoption

SAN FRANCISCO -- Emergency department visits for young adults, ages 19 to 25, might have decreased slightly overall following the implementation of the Affordable Care Act (ACA), but visits for mental illnesses and diseases of the circulatory system increased substantially among that age group.

That’s according to a study published online recently by Annals of Emergency Medicine.

"Increased health insurance coverage reduced ER visits by young people for conditions that can be treated in office-based settings, but the lack of mental health resources continues to bring these patients to the ER in ever larger numbers," explained study author Renee Hsia, MD, of the University of California San Francisco. "We also saw an increase in patients with diseases of the circulatory system, such as non-specific chest pain.”

On the other hand, Hsia noted a big decrease in ED visits for complications of pregnancy “which is important as it was among the top reasons they visited the emergency department prior to the implementation of the ACA."

To determine what effect the ACA had on patient visits, researchers conducted a before-and-after study in California, Florida, and New York. Patients age 19 to 25 were compared to patients 26 to 31 during the same time periods, September 2009 through August 2010 vs. January through December 2011.

The researchers analyzed 10,158,254 ED visits made by 4,734,409 patients. After the implementation of the 2010 ACA provision, young adults had a relative decrease of 0.5% ED visits per 1,000 people compared with the older group.

Results indicate that the rate of ED visits by young people decreased by 0.5% after ACA implementation. Yet, the relative risk of a young adult ever to visit the ED increased by 2.6% for mental illness and by 4.8% for diseases of the circulatory system such as cardiac dysrhythmias or nonspecific chest pain.

The relative rate of emergency visits decreased by 3.7% for pregnancy-related diagnoses, meanwhile, and by 3.3% for diseases of the skin, such as cellulitis and abscesses.

Overall, study authors note that only white and black young adults decreased their frequency in seeking emergency care, not Hispanics.

“Our results indicate that increased coverage has kept young adults out of the ED for specific conditions that can be cared for through access to other channels,” the article concludes. “As EDs face capacity challenges, these results are encouraging and offer insight into what could be expected under further insurance expansions from health care reform.”

"The troubling finding is that young adults were more likely to visit the emergency department for mental illnesses following expanded insurance coverage under the ACA," Hsia added in an American College of Emergency Physicians press release. "Significant barriers to care for mental health issues persist, leaving these patients little choice but to seek care in the only place they know they can get it: the ER."

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