December 2008

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


Background and Objective: An economic downturn and state budget cuts led to Medicaid program changes across the country in the early part of this decade. In Oregon, state budget constraints led to a restructuring of their Medicaid program, the Oregon Health Plan (OHP). In March 2003, extensive cutbacks were made to the OHP leading to disenrollment of nearly 80% of the enrollees who were non-categorical (part of the OHP expansion group). This study focused on whether there was a change in use of Oregon emergency departments (EDs) for chronic illnesses after versus before the OHP policy changes and, if so, if the pattern of change varied among payer groups. A subset of visits by patients with behavioral health diagnoses was also studied to determine if having a behavioral health problem altered the potential relationship between ED utilization for chronic illnesses and the OHP policy changes among different payer groups. Methods: ED claims data ranging from March 1, 2001 through February 28, 2005 were examined for 22 Oregon hospitals. Using multivariate regression, we compared the proportion of chronic illness visits (measured as chronic ambulatory sensitive conditions) after versus before the OHP policy changes by payer group for all visits and for the subset of behavioral health visits. Results: Uninsured visits were significantly more likely to be for a chronic ACS condition after versus before the OHP policy changes (OR = 1.10, CI 1.05, 1.16). These increased odds were not seen in the commercial or the OHP groups (OR = 0.97, CI 0.93, 1.00 and OR = 1.00, CI 0.96, 1.04). This change seen in uninsured visits differed significantly from the lack of change seen in the commercial and OHP groups (Wald p =<0.01). In the behavioral health subgroup of visits, the association between chronic ACS visits and time period for the uninsured payer status was also appreciated (OR = 1.16, CI 1.04, 1.28). However, the change seen in the uninsured group was not shown to be statistically significant (Wald p = 0.09), thought to be due to lack of power. Conclusion: The policy changes in the OHP led to cutbacks in March of 2003. These cutbacks were followed by a significant increase in the proportion of preventable uninsured visits to Oregon emergency departments for chronic illnesses. The association seen between visits for chronic illnesses in the uninsured, and the OHP policy change, raises the need for further debate about the most cost-effective way to deal with rising health care costs.




School of Medicine



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