Impact of Demographics on Healthcare Utilization

Introduction The Affordable Care Act (ACA) was promoted with two goals: expanding health insurance coverage and reducing healthcare costs. Expanded coverage is expected to partially reduce costs. Emergency department (ED) visits are costlier than comparable primary care physician visits. If uninsured patients use the local ED more often than insured patients with comparable conditions, insuring them may change usage and lower costs. Some reports in the literature do not fit this model of ED usage. In one study, nonurgent ED visits were mainly the result of patient uncertainty about the severity of their condition. While trained medical personnel distinguished urgent and nonurgent cases after the fact, initial presentations were similar. In Oregon, an expansion of Medicaid increased health insurance coverage; ED usage increased rather than decreased. Thus, the motivating narrative about insurance coverage and ED usage informing the ACA may not be the complete story. Reduction of hospital readmissions is also expected to cut costs under the ACA. Hospital process improvements are expected to realize this reduction. Recently it was reported that up to 60% of hospital readmissions are predicted by patient demographics, raising questions about how much control a hospital has over its readmission rate. This research will examine whether data collected via syndromic surveillance can corroborate these findings.