[ { "key": "2G5ZN9HL", "version": 11, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/2G5ZN9HL", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/2G5ZN9HL", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/AMSSKMIS", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "2G5ZN9HL", "version": 11, "parentItem": "AMSSKMIS", "itemType": "attachment", "linkMode": "imported_url", "title": "Snapshot", "accessDate": "2025-05-24T11:26:21Z", "url": "https://www.kff.org/medicaid/issue-brief/an-overview-of-delivery-system-reform-incentive-payment-waivers/", "note": "", "contentType": "text/html", "charset": "utf-8", "filename": "an-overview-of-delivery-system-reform-incentive-payment-waivers.html", "md5": null, "mtime": null, "tags": [], "relations": {}, "dateAdded": "2025-05-24T11:26:21Z", "dateModified": "2025-05-24T11:26:21Z" } }, { "key": "AMSSKMIS", "version": 10, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/AMSSKMIS", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/AMSSKMIS", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Gates et al.", "parsedDate": "2014-09-29", "numChildren": 1 }, "data": { "key": "AMSSKMIS", "version": 10, "itemType": "blogPost", "title": "An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers", "creators": [ { "creatorType": "author", "firstName": "Alexandra", "lastName": "Gates" }, { "creatorType": "author", "firstName": "Robin", "lastName": "Rudowitz" }, { "creatorType": "author", "firstName": "Jocelyn Guyer", "lastName": "Published" } ], "abstractNote": "This brief will examine similarities and difference across key elements of DSRIP waivers. The states included in this analysis are: California, Texas, Kansas, New Jersey, Massachusetts, and New York. The key elements of DSRIP initiatives that will be explored in this analysis include: the goals and objectives of the DSRIP initiative; eligible providers; projects and organization; allocation of funds; data collection and evaluation/reporting; and financing of DSRIP waivers.", "blogTitle": "KFF", "websiteType": "", "date": "2014-09-29", "DOI": "", "citationKey": "", "url": "https://www.kff.org/medicaid/issue-brief/an-overview-of-delivery-system-reform-incentive-payment-waivers/", "accessDate": "2025-05-24T11:26:16Z", "ISSN": "", "shortTitle": "", "language": "en-US", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2025-05-24T11:26:16Z", "dateModified": "2025-05-24T11:26:16Z" } }, { "key": "IHQRJH3D", "version": 13, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/IHQRJH3D", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/IHQRJH3D", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Medford-Davis et al.", "parsedDate": "2015-11", "numChildren": 1 }, "data": { "key": "IHQRJH3D", "version": 13, "itemType": "journalArticle", "title": "The Patient Protection and Affordable Care Act's Effect on Emergency Medicine: A Synthesis of the Data", "creators": [ { "creatorType": "author", "firstName": "Laura N.", "lastName": "Medford-Davis" }, { "creatorType": "author", "firstName": "Vidya", "lastName": "Eswaran" }, { "creatorType": "author", "firstName": "Rohan M.", "lastName": "Shah" }, { "creatorType": "author", "firstName": "Cedric", "lastName": "Dark" } ], "abstractNote": "This review synthesizes the existing literature to provide evidence-based predictions for the future of emergency care in the United States as a result of the Patient Protection and Affordable Care Act, with a focus on emergency department (ED) visit volume, acuity, and reimbursement. Patient behavior will likely be quite different for patients gaining Medicaid than for those gaining private insurance through the Marketplaces. Despite the threat of the individual mandate, not all uninsured patients will enroll, and those who choose to enroll will likely be a different population from those who remain uninsured. New Medicaid enrollees will be a sicker population and will likely increase their number of ED visits substantially. Their acuity will be higher at first but will then revert to the traditionally high number of low-acuity visits made by Medicaid patients. Most patients enrolling through the Marketplace are choosing high-deductible health plans, and they will initially avoid the ED because of high out-of-pocket costs but may present later and sicker after self-rationing their care. Most patients gaining health coverage through the Affordable Care Act will be shifting from uninsured to either Medicaid or private insurance, both of which reimburse more than self-pay, so ED collections should increase. Because of the differences between Medicaid and Marketplace plans, there will be a difference in ED volume, acuity, and financial outcomes, depending on states' current demographics, whether states expand Medicaid, and how aggressively states advertise new options for coverage in Medicaid or state health insurance Marketplaces.", "publicationTitle": "Annals of Emergency Medicine", "publisher": "", "place": "", "date": "Nov 2015", "volume": "66", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "496-506", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "10.1016/j.annemergmed.2015.04.007", "citationKey": "", "url": "", "accessDate": "", "PMID": "25976250", "PMCID": "", "ISSN": "1097-6760", "archive": "", "archiveLocation": "", "shortTitle": "The Patient Protection and Affordable Care Act's Effect on Emergency Medicine", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Emergency Medicine", "type": 1 }, { "tag": "Emergency Service, Hospital", "type": 1 }, { "tag": "Forecasting", "type": 1 }, { "tag": "Health Care Reform", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Insurance, Health", "type": 1 }, { "tag": "Patient Protection and Affordable Care Act", "type": 1 }, { "tag": "United States", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2016-09-21T01:54:13Z", "dateModified": "2016-09-21T01:54:13Z" } }, { "key": "KD8U5RWW", "version": 8, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/KD8U5RWW", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/KD8U5RWW", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/IHQRJH3D", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "KD8U5RWW", "version": 8, "parentItem": "IHQRJH3D", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2016-09-21T01:54:13Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/25976250", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2016-09-21T01:54:13Z", "dateModified": "2016-09-21T01:54:13Z" } }, { "key": "PU2PFNV5", "version": 13, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/PU2PFNV5", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/PU2PFNV5", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Akosa Antwi et al.", "parsedDate": "2015-06", "numChildren": 1 }, "data": { "key": "PU2PFNV5", "version": 13, "itemType": "journalArticle", "title": "Changes in Emergency Department Use Among Young Adults After the Patient Protection and Affordable Care Act's Dependent Coverage Provision", "creators": [ { "creatorType": "author", "firstName": "Yaa", "lastName": "Akosa Antwi" }, { "creatorType": "author", "firstName": "Asako S.", "lastName": "Moriya" }, { "creatorType": "author", "firstName": "Kosali", "lastName": "Simon" }, { "creatorType": "author", "firstName": "Benjamin D.", "lastName": "Sommers" } ], "abstractNote": "STUDY OBJECTIVE: Since September 2010, the Patient Protection and Affordable Care Act has allowed young adults to remain as dependents on their parents' private health plans until age 26 years. This insurance expansion could improve the efficiency of medical care delivery by reducing unnecessary emergency department (ED) use. We evaluated the effect of this provision on ED use among young adults.\nMETHODS: We used a nationally representative ED visit database of more than 17 million visits from 2007 to 2011. Our analysis compared young adults aged 19 to 25 years (the age group targeted by the law) with slightly older adults aged 27 to 29 years (control group), before and after the implementation of the law.\nRESULTS: The quarterly ED-visit rate decreased by 1.6 per 1,000 population (95% confidence interval 1.2 to 2.1) among targeted young adults after the implementation of the provision, relative to a comparison group. The decrease was concentrated among women, weekday visits, nonurgent conditions, and conditions that can be treated in other settings. We found no effect among weekend visits or visits due to injuries or urgent conditions. The provision also changed the health insurance composition of ED visits; the fraction of privately insured young adults increased, whereas the fraction of those insured through Medicaid and those uninsured decreased.\nCONCLUSION: The Patient Protection and Affordable Care Act dependent coverage expansion was associated with a statistically significant yet modest decrease in ED use, concentrated in the types of ED visits that were likely to be responsive to changes to insurance status. In response to the law, young adults appeared to have altered their visit pattern to reflect a more efficient use of medical care.", "publicationTitle": "Annals of Emergency Medicine", "publisher": "", "place": "", "date": "Jun 2015", "volume": "65", "issue": "6", "section": "", "partNumber": "", "partTitle": "", "pages": "664-672.e2", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "10.1016/j.annemergmed.2015.01.010", "citationKey": "", "url": "", "accessDate": "", "PMID": "25769461", "PMCID": "", "ISSN": "1097-6760", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Age Factors", "type": 1 }, { "tag": "Emergency Service, Hospital", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Insurance Coverage", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Patient Protection and Affordable Care Act", "type": 1 }, { "tag": "Young Adult", "type": 1 } ], "collections": [], "relations": {}, "dateAdded": "2016-09-21T01:48:40Z", "dateModified": "2016-09-21T01:48:40Z" } }, { "key": "SNKHNSVA", "version": 7, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/SNKHNSVA", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/SNKHNSVA", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/PU2PFNV5", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "SNKHNSVA", "version": 7, "parentItem": "PU2PFNV5", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2016-09-21T01:48:40Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/25769461", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2016-09-21T01:48:40Z", "dateModified": "2016-09-21T01:48:40Z" } }, { "key": "B7NHEQ5G", "version": 6, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/B7NHEQ5G", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/B7NHEQ5G", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/GXSPPNFI", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "B7NHEQ5G", "version": 6, "parentItem": "GXSPPNFI", "itemType": "attachment", "linkMode": "imported_url", "title": "PubMed Central Full Text PDF", "accessDate": "2016-09-21T01:46:46Z", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917390/pdf/nihms795622.pdf", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Hernandez-Boussard et al. - 2016 - Relationship of Affordable Care Act Implementation.pdf", "md5": "975cb22da598823d99d59b1a461fd89a", "mtime": 1474422406000, "tags": [], "relations": {}, "dateAdded": "2016-09-21T01:46:46Z", "dateModified": "2016-09-21T01:46:47Z" } }, { "key": "GXSPPNFI", "version": 13, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/GXSPPNFI", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/GXSPPNFI", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Hernandez-Boussard et al.", "parsedDate": "2016-06", "numChildren": 2 }, "data": { "key": "GXSPPNFI", "version": 13, "itemType": "journalArticle", "title": "Relationship of Affordable Care Act Implementation to Emergency Department Utilization Among Young Adults", "creators": [ { "creatorType": "author", "firstName": "Tina", "lastName": "Hernandez-Boussard" }, { "creatorType": "author", "firstName": "Doug", "lastName": "Morrison" }, { "creatorType": "author", "firstName": "Ben A.", "lastName": "Goldstein" }, { "creatorType": "author", "firstName": "Renee Y.", "lastName": "Hsia" } ], "abstractNote": "Study objective\nThe 2010 provision of the Patient Protection and Affordable Care Act (ACA) extended eligibility for health insurance for young adults aged 19 to 25 years. It is unclear, however, how expanded coverage changes health care behavior and promotes efficient use of emergency department (ED) services. Our objective was to use population-level emergency department data to characterize any changes in diagnoses seen in ED among young adults since the implementation of the ACA dependent coverage expansion.\n\nMethods\nWe performed a difference-in-differences analysis of 2009 to 2011 ED visits from California, Florida, and New York, using all-capture administrative data to determine how the use of ED services changed for clinical categories after the ACA provision among young adults aged 19 to 25 years compared with slightly older adults unaffected by the provision, aged 26 to 31 years.\n\nResults\nWe analyzed a total of 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. For the majority of diagnostic categories, young adults’ rates and risk of visit did not change relative to that of slightly older adults after the implementation of the ACA. However, although young adults’ ED visits significantly increased for mental illnesses (2.6%) and diseases of the circulatory system (eg, nonspecific chest pain) (4.8%), visits decreased for pregnancy-related diagnoses and diseases of the skin (eg, cellulitis, abscess) compared with that of the older group (3.7% and 3.1%, respectively).\n\nConclusion\nOur 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. 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.", "publicationTitle": "Annals of emergency medicine", "publisher": "", "place": "", "date": "2016-6", "volume": "67", "issue": "6", "section": "", "partNumber": "", "partTitle": "", "pages": "714-720.e1", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "10.1016/j.annemergmed.2015.11.034", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917390/", "accessDate": "2016-09-21T01:46:46Z", "PMID": "26778281", "PMCID": "PMC4917390", "ISSN": "0196-0644", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2016-09-21T01:46:46Z", "dateModified": "2016-09-21T01:46:46Z" } }, { "key": "76G47QDC", "version": 5, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/76G47QDC", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/76G47QDC", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/GXSPPNFI", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "76G47QDC", "version": 5, "parentItem": "GXSPPNFI", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Central Link", "accessDate": "2016-09-21T01:46:46Z", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917390/", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2016-09-21T01:46:46Z", "dateModified": "2016-09-21T01:46:46Z" } }, { "key": "XHUZEB57", "version": 4, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/XHUZEB57", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/XHUZEB57", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/TZWBFHBG", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "XHUZEB57", "version": 4, "parentItem": "TZWBFHBG", "itemType": "attachment", "linkMode": "imported_url", "title": "PubMed Central Full Text PDF", "accessDate": "2016-09-21T01:45:44Z", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453768/pdf/nihms-693601.pdf", "note": "", "contentType": "application/pdf", "charset": "", "filename": "Hernandez-Boussard et al. - 2014 - The Affordable Care Act Reduces Emergency Departme.pdf", "md5": "aba26ec8c7267fa898a499838df937ab", "mtime": 1474422344000, "tags": [], "relations": {}, "dateAdded": "2016-09-21T01:45:44Z", "dateModified": "2016-09-21T01:45:45Z" } }, { "key": "TZWBFHBG", "version": 13, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/TZWBFHBG", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/TZWBFHBG", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Hernandez-Boussard et al.", "parsedDate": "2014-09", "numChildren": 2 }, "data": { "key": "TZWBFHBG", "version": 13, "itemType": "journalArticle", "title": "The Affordable Care Act Reduces Emergency Department Use By Young Adults: Evidence From Three States", "creators": [ { "creatorType": "author", "firstName": "Tina", "lastName": "Hernandez-Boussard" }, { "creatorType": "author", "firstName": "Carson S.", "lastName": "Burns" }, { "creatorType": "author", "firstName": "N. Ewen", "lastName": "Wang" }, { "creatorType": "author", "firstName": "Laurence C.", "lastName": "Baker" }, { "creatorType": "author", "firstName": "Benjamin A.", "lastName": "Goldstein" } ], "abstractNote": "The Affordable Care Act (ACA) extended eligibility for health insurance for young adults ages 19–25. This extension may have affected how young adults use emergency department (ED) care and other health services. To test the impact of the ACA on how young adults used ED services, we used 2009–11 state administrative records from California, Florida, and New York to compare changes in ED use in young adults ages 19–25 before and after the ACA provision was implemented with changes in the same period for people ages 26–31 (the control group). Following implementation of the ACA provision, the younger group had a decrease of 2.7 ED visits per 1,000 people compared to the older group—a relative change of −2.1 percent. The largest relative decreases were found in women (−3.0 percent) and blacks (−3.4 percent). This relative decrease in ED use implies a total reduction of more than 60,000 visits from young adults ages 19–25 across the three states in 2011. When we compared the probability of ever using the ED before and after implementation of the ACA provision, we found a minimal decrease (−0.4 percent) among the younger group compared to the older group. This suggests that the change in the number of visits was driven by fewer visits among ED users, not by changes in the number of people who ever visited the ED.", "publicationTitle": "Health affairs (Project Hope)", "publisher": "", "place": "", "date": "2014-9", "volume": "33", "issue": "9", "section": "", "partNumber": "", "partTitle": "", "pages": "1648-1654", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Health Aff (Millwood)", "DOI": "10.1377/hlthaff.2014.0103", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453768/", "accessDate": "2016-09-21T01:45:44Z", "PMID": "25201671", "PMCID": "PMC4453768", "ISSN": "0278-2715", "archive": "", "archiveLocation": "", "shortTitle": "The Affordable Care Act Reduces Emergency Department Use By Young Adults", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2016-09-21T01:45:44Z", "dateModified": "2016-09-21T01:45:44Z" } }, { "key": "UJSWKMES", "version": 3, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/UJSWKMES", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/UJSWKMES", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/TZWBFHBG", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "UJSWKMES", "version": 3, "parentItem": "TZWBFHBG", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Central Link", "accessDate": "2016-09-21T01:45:44Z", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453768/", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2016-09-21T01:45:44Z", "dateModified": "2016-09-21T01:45:44Z" } }, { "key": "4CW6NKVI", "version": 13, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/4CW6NKVI", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/4CW6NKVI", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } }, "creatorSummary": "Smulowitz et al.", "parsedDate": "2014-08", "numChildren": 1 }, "data": { "key": "4CW6NKVI", "version": 13, "itemType": "journalArticle", "title": "Increased use of the emergency department after health care reform in massachusetts", "creators": [ { "creatorType": "author", "firstName": "Peter B.", "lastName": "Smulowitz" }, { "creatorType": "author", "firstName": "James", "lastName": "O'Malley" }, { "creatorType": "author", "firstName": "Xiaowen", "lastName": "Yang" }, { "creatorType": "author", "firstName": "Bruce E.", "lastName": "Landon" } ], "abstractNote": "STUDY OBJECTIVE: With implementation of the Patient Protection and Affordable Care Act, 30 million individuals are predicted to gain access to health insurance. The experience in Massachusetts, which implemented a similar reform beginning in 2006, should provide important lessons about the effect of health care reform on emergency department (ED) utilization. Our objective is to understand the extent to which Massachusetts health care reform was associated with changes in ED utilization.\nMETHODS: We compared changes in ED utilization at the population level for individuals from areas of the state that were affected minimally by health care reform with those from areas that were affected the most, as well as for those younger than 65 years and aged 65 years or older. We used a difference-in-differences identification strategy to compare rates of ED visits in the prereform period, during the reform, and in the postreform period. Because we did not have population-level data on insurance status, we estimated area-level insurance rates by using the percentage of actual visits made during each period by individuals with insurance.\nRESULTS: We studied 13.3 million ED visits during 2004 to 2009. Increasing insurance coverage in Massachusetts was associated with increasing use of the ED; these results were consistent across all specifications, including the younger than 65 years versus aged 65 years or older comparison. Depending on the model used, the implementation of health care reform was estimated to result in an increase in ED visits per year of between 0.2% and 1.2% within reform and 0.2% and 2.2% postreform compared with the prereform period.\nCONCLUSION: The implementation of health care reform in Massachusetts was associated with a small but consistent increase in the use of the ED across the state. Whether this was due to the elimination of financial barriers to seeking care in the ED, a persistent shortage in access to primary care for those with insurance, or some other cause is not entirely clear and will need to be addressed in future research.", "publicationTitle": "Annals of Emergency Medicine", "publisher": "", "place": "", "date": "Aug 2014", "volume": "64", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "107-115.e3", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "10.1016/j.annemergmed.2014.02.011", "citationKey": "", "url": "", "accessDate": "", "PMID": "24656759", "PMCID": "", "ISSN": "1097-6760", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2016-09-21T01:44:40Z", "dateModified": "2016-09-21T01:44:40Z" } }, { "key": "QMNBQBH5", "version": 2, "library": { "type": "group", "id": 707552, "name": "healthcare_reform_ED", "links": { "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/707552/items/QMNBQBH5", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/healthcare_reform_ed/items/QMNBQBH5", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/707552/items/4CW6NKVI", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1161085, "username": "webakerma", "name": "William Baker", "links": { "alternate": { "href": "https://www.zotero.org/webakerma", "type": "text/html" } } } }, "data": { "key": "QMNBQBH5", "version": 2, "parentItem": "4CW6NKVI", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-09-01T01:27:38Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/24656759", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2016-09-21T01:44:40Z", "dateModified": "2016-09-21T01:44:40Z" } } ]