Emergency Department and Primary Care Use in Massachusetts 5 Years After Health Reform

UMMS Affiliation

Graduate School of Biomedical Sciences; Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Emergency Medicine | Epidemiology | Health Policy | Health Services Administration | Health Services Research | Insurance | Primary Care


OBJECTIVE: Conceptually, access to primary care (through insurance) should reduce emergency department (ED) visits for primary care sensitive (PCS) conditions. We sought to identify characteristics of insured Massachusetts residents associated with PCS ED use, and compare such use for public versus private insurees.

POPULATION AND SETTING: People under age 65 in the Massachusetts All-Payer Claims Data, 2011-2012.

STUDY DESIGN: Retrospective, observational analysis of PCS ED use with nonurgent, urgent/primary care treatable, and urgent/potentially avoidable visits being considered PCS. We predicted utilization in 2012 using multivariable regression models and data available in 2011 administrative records.

PRINCIPAL FINDINGS: Among 2,269,475 nonelderly Massachusetts residents, 40% had public insurance. Among public insurees, PCS ED use was higher than for private (mean, 36.5 vs. 9.0 per 100 persons; adjusted risk ratio, 2.53; 95% confidence limits, 2.49-2.56), while having any primary care visit was less common (70% vs. 83%), as was having any visit to one's own (attributed) primary care provider (38% vs. 44%).

CONCLUSIONS: Public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.


access to care, claims data, emergency department, health insurance, Medicaid, primary care, quality measurement, risk adjustment, state health reform, utilization

DOI of Published Version



Med Care. 2019 Feb;57(2):101-108. doi: 10.1097/MLR.0000000000001025. Link to article on publisher's site

Journal/Book/Conference Title

Medical care

PubMed ID


Related Resources

Link to Article in PubMed