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Insurance expansion associated with reduced use of emergency psychiatric services

      The introduction of the Affordable Care Act (ACA) in 2010 allowed states to expand the availability of public insurance to their citizens [

      Anonymous. Patient protection and affordable care act: preexisting condition exclusions, lifetime and annual limits, rescissions, and patient protections. Federal Register 2010; vol. 75(123):37187–37241.

      ]. Thirty-five states ultimately adopted insurance expansion. It was widely anticipated that the law would alter utilization of medical services. One of the surprising changes has been an increase in the utilization of emergency department (ED) services for medical [
      • Nikpay S.
      • Freedman S.
      • Levy H.
      • Buckmueller T.
      Effect of the Affordable Care Act Medicaid expansion on emergency department visits: evidence from state-level emergency department databases.
      ,
      • Xu T.
      • Klein E.Y.
      • Zhou M.
      • Lowenthal J.
      • Sharfstein J.M.
      • Peterson S.M.
      Emergency department utilization among the uninsured during insurance expansion in Maryland.
      ] and substance abuse services [
      • Moulin A.
      • Evans E.J.
      • Xing G.
      • Melnikow J.
      Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
      ,
      • Hooker E.A.
      • Mallow P.J.
      • Oglesby M.M.
      Characteristics and trends of emergency department visits in the United States (2010-2014).
      ]. This increase occurred despite an increase in utilization of outpatient and preventative services, but not for non-substance-related mental health services [
      • Burns M.E.
      • Dague L.
      • DeLeire T.
      • Dorsch M.
      • Friedsam D.
      • Leininger L.J.
      • et al.
      The effects of expanding public insurance to rural low-income childless adults.
      ]. Similarly, homeless patients with substance abuse are more likely to utilize ED services if they have public insurance [
      • Moulin A.
      • Evans E.J.
      • Xing G.
      • Melnikow J.
      Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
      ]. However, the specific effect on general psychiatric ED utilization has not been investigated.

      Keywords

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      References

      1. Anonymous. Patient protection and affordable care act: preexisting condition exclusions, lifetime and annual limits, rescissions, and patient protections. Federal Register 2010; vol. 75(123):37187–37241.

        • Nikpay S.
        • Freedman S.
        • Levy H.
        • Buckmueller T.
        Effect of the Affordable Care Act Medicaid expansion on emergency department visits: evidence from state-level emergency department databases.
        Ann Emerg Med. 2017; 70: 215-225.e6https://doi.org/10.1016/j.annemergmed.2017.03.023
        • Xu T.
        • Klein E.Y.
        • Zhou M.
        • Lowenthal J.
        • Sharfstein J.M.
        • Peterson S.M.
        Emergency department utilization among the uninsured during insurance expansion in Maryland.
        Ann Emerg Med. 2018; 72: 156-165https://doi.org/10.1016/j.annemergmed.2018.04.025
        • Moulin A.
        • Evans E.J.
        • Xing G.
        • Melnikow J.
        Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
        West J Emerg Med. 2018; 19: 902-906
        • Hooker E.A.
        • Mallow P.J.
        • Oglesby M.M.
        Characteristics and trends of emergency department visits in the United States (2010-2014).
        J Emerg Med. 2019; 56: 344-351https://doi.org/10.5811/westjem.2018.9.38954
        • Burns M.E.
        • Dague L.
        • DeLeire T.
        • Dorsch M.
        • Friedsam D.
        • Leininger L.J.
        • et al.
        The effects of expanding public insurance to rural low-income childless adults.
        Health Serv Res. 2014; 49: 2173-2187https://doi.org/10.1111/1475-6773.12233
        • El-Mallakh R.S.
        • Cowdry R.W.
        • Pettigrew I.E.
        Evaluating change: a simple technique for determining statistical significance of proportional criteria.
        J Healthcare Qual. 1994; 16: 14-17https://doi.org/10.1111/j.1945-1474.1994.tb00681.x
        • Campbell C.I.
        • Parthasarathy S.
        • Altschuler A.
        • Young-Wolff K.C.
        • Satre D.D.
        Characteristics of patients with substance use disorder before and after the Affordable Care Act.
        Drug Alcohol Depend. 2018; 193: 124-130https://doi.org/10.1016/j.drugalcdep.2018.08.028
        • Swan G.A.
        • Foley K.L.
        The perceived impact of the patient protection and Affordable Care Act on North Carolina’s free clinics.
        N C Med J. 2016; 77: 23-29https://doi.org/10.18043/ncm.77.1.23
        • Ossei-Owusu S.
        Code red: the essential yet neglected role of emergency care in health law reform.
        Am J Law Med. 2017; 43: 344-387https://doi.org/10.1177/0098858817753404
        • Alegria M.
        • Lin J.
        • Chen C.N.
        • Duan N.
        • Cook B.
        • Meng X.L.
        The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services.
        Health Serv Res. 2012; 47: 1322-1344https://doi.org/10.1111/j.1475-6773.2012.01403.x
        • Yanuck J.
        • Hicks B.
        • Anderson C.
        • Nillimek J.
        • Lotfipour S.
        • Chakravarthy B.
        The Affordable Care Act: disparities in emergency department use for mental health diagnoses in young adults.
        World J Emerg Med. 2017; 8: 206-213https://doi.org/10.5847/wjem.j.1920-8642.2017.03.008
        • Golberstein E.
        • Busch S.H.
        • Zaha R.
        • Greenfield S.F.
        • Beardslee W.R.
        • Meara E.
        Effect of the Affordable Care Act’s young adult insurance expansions on hospital-based mental health care.
        Am J Psychiatry. 2015; 172: 182-189https://doi.org/10.1176/appi.ajp.2014.14030375