Article Title

Using Emergency Room Visitation Data to Identify Health Improvement Opportunities for Medicaid Enrollees

Publication Date



emergency room utilization, dental care


Background/Aims: Medicaid enrollees face many unique barriers when it comes to maintaining their health. Unfortunately, it is not always easy to identify these barriers and measure their consequences. One approach to understanding these disparities is to examine emergency room (ER) visitation patterns. By comparing ER utilization for individuals enrolled in Medicaid versus commercial insurance products, this study hopes to identify disparities in order to direct future research and shape public policy.

Methods: Claims for all ER visits in 2011 were obtained from a regional health plan for individuals enrolled in Medicaid or commercial fully insured products. Data from over 130,000 ER visits were captured. Diagnostic grouping software was used to determine the reason for each visit and visit frequencies for these groupings were calculated and compared across populations.

Results: The percentage of visits among Medicaid versus commercial enrollees was substantially larger for upper respiratory infections (URI; 10.3% vs. 5.9%), otitis media (OM; 4.7% vs. 2.2%) and disorders of the teeth and jaw (DTJ; 3.3% vs. 1%). Follow-up analysis examining these differences by age found that URI and OM accounted for the first and second highest disparity for individuals aged 0-12 years (18% vs. 14% and 11% vs. 8%, respectively), but this difference quickly dropped as age increased. Visits for DTJ were low among the 0–12 age group (< 1% vs. < 1%) but were responsible for the largest visitation disparity for individuals age 13–25 (1% vs. 5%) and 26–38 (2% vs 6%). DTJ accounted for the second-largest disparity for individuals age 39–64 (4% vs. 1%).

Conclusion: A number of avenues for future research can be drawn from these findings, particularly those involving DTJ. Though patterns involving children may indicate environmental influences, they also may be a result of parents using the ER for primary care. Differences involving DTJ, however, are highly suggestive of unmet needs –– most likely a mix of access to adequate dental care and treatment for drug addiction. Future research and policy implementation in this area will be crucial to improving the health and well-being of low-income populations.




June 30th, 2016


August 12th, 2016