Now that the ACA (aka “Obamacare”) has gotten past the government shutdown, past the debt ceiling crisis, and is almost to grandmother’s house (once the website is up and working), it’s time to think about how it will affect surveillance.
Syndromic surveillance relies upon emergency department chief complaints for early indications of population health events. Emergency department chief complaints work well for population surveillance because they provide early data on potentially severe cases and are widely available from most facilities.
Since this type of surveillance is tied so closely to emergency department utilization, it is affected by changes in the healthcare seeking behavior of the sick and injured. It is also an excellent method of measuring the impact of the ACA.
Will the ACA result in an overall decrease in emergency department usage?
For years an urban legend has circulated that the poor and uninsured use emergency departments as a substitute for a doctor visit because hospitals are non-profits and won’t turn these sick and injured patients away. In theory, the ACA will provide health insurance coverage to this group and they can then go to the doctor of their choice.
This thinking is part of the motivation for expanding state Medicaid programs and providing insurance subsidies. Hospitals will no longer be subsidizing indigent care, costs won’t be transferred to other, insured patients. Hospitals, especially those in urban poor centers will be better able to serve their community and in turn the health of the community will improve.
Improved health through earlier access to care is expected to further reduce emergency department visits, along with costs. An average emergency department visit costs nearly ten times a visit to the doctor’s office.
This all sounds good. Unless, of course, the premise is unsound. If that is the case, the ACA could even raise emergency department visits.
The key to untangling this is understanding the health seeking behavior of the sick and injured. It seems like a simple question, but why does someone seek healthcare and how do they pick their provider?
Bringing this home to Health Monitoring Systems, we are beginning to look at how EpiCenter could measure the impact of policy on healthcare utilization. On the flip side, we are also considering whether and how EpiCenter’s analysis will be impacted by healthcare reform.