Freestanding Emergency Department Entry and Market‐level Spending on Emergency Care

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dc.citation.firstpage1221
dc.citation.lastpage1231
dc.contributor.authorHo, Vivian
dc.contributor.authorXu, Yingying
dc.contributor.authorAkhter, Murtaza
dc.contributor.orgJames A. Baker III Institute for Public Policy
dc.date.accessioned2020-02-14T16:39:36Z
dc.date.available2020-02-14T16:39:36Z
dc.description.abstractBackground: Freestanding emergency departments (FrEDs) could reduce wait times in overcrowded emergency departments (EDs), but they might also increase usage and overall spending for emergency care. We investigate the relationship between the number of FrEDs entering a local market and overall spending on emergency care. Methods: We accessed data from Arizona, Florida, North Carolina, and Texas in Blue Cross Blue Shield Axis; a limited data set of deidentified insurance data claims that we linked to Public Use Microdata Area (PUMA) data from the American Community Survey; and lists of licensed FrEDs from state agencies. Regression analysis was used to estimate the association between changes in the number of FrEDs in 495 PUMAs and total spending on emergency care, out‐of‐pocket spending, utilization, and price per visit from January 2013 to December 2017. Final estimates came from a PUMA‐level fixed‐effects model, with controls for state, quarter, and PUMA‐level demographics. Results: Entry of an additional FrED in a PUMA was associated with a 3.6 percentage point (pp; CI = 2.4 to 4.9) increase in emergency provider reimbursement per insured beneficiary in Texas, Florida, and North Carolina. There was no change in spending (2.5 pp; CI = −8.2 to 3.1) associated with a FrED's entry in Arizona. Entry of an additional FrED was associated with a 0.18 (CI = 0.12 to 0.23) increase in the number of emergency care visits per 100 enrollees in Texas, Florida, and Arizona. In contrast, entry of another FrED was not associated with a change in utilization (−0.03; CI = −0.09 to 0.02) in North Carolina. Estimated out‐of‐pocket payments for emergency care increased 3.6 pp (CI = 2.5 to 4.8) with the entry of a FrED in Texas, Florida, and Arizona, but declined by 15.3 pp (CI = −26.8 to −3.7) in North Carolina. Conclusions: Rather than functioning as substitutes for hospital‐based EDs, FrEDs have increased local market spending on emergency care in three of four states’ markets where they have entered. State policy makers and researchers should carefully track spending and utilization of emergency care as FrEDs disseminate to better understand their potential health benefits and cost implications for patients.
dc.identifier.citationHo, Vivian, Xu, Yingying and Akhter, Murtaza. "Freestanding Emergency Department Entry and Market‐level Spending on Emergency Care." <i>Academic Emergency Medicine,</i> 26, no. 11 (2019) Wiley: 1221-1231. https://doi.org/10.1111/acem.13848.
dc.identifier.digitalFreestandingEmergency
dc.identifier.doihttps://doi.org/10.1111/acem.13848
dc.identifier.urihttps://hdl.handle.net/1911/108033
dc.publisherWiley
dc.rightsThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.titleFreestanding Emergency Department Entry and Market‐level Spending on Emergency Care
dc.typeJournal article
dc.type.dcmiText
dc.type.publicationpublisher version
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