Emergency Room Overutilization Essay

Emergency Room Overutilization Essay

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Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the over utilization of hospital emergency rooms. This is a direct result of not having a primary care physician and/or family doctor who is the main source of healthcare delivery for an individual and/or entire family The traditional Medicaid program does not offer, or require, recipients to choose a primary care physician like, its counterpart, Medicare. Medicare still operates under the traditional fee-for-service methodology and does not require beneficiaries to identify and primary provider as well as having direct access to specialty services. This allows a cost sharing approach which results in higher out-of-pocket expenses and does not cover drug or prescription benefits.

In an effort to offer better healthcare services and access as well as reduce costs the federal government allowed the States to turn to managed care and proposed a mandatory statewide implementation for the Medicaid population. In order to make major changes like these, states have to request waivers of Medicaid regulatio...


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...sive.(Practice Trends)." Clinical Psychiatry News 33.2 (Feb 2005): 88(1). Academic OneFile. Thomson Gale. University of Phoenix. Retrieved February 25, 2013 from:
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5. Roohan, Patrick J., Anarella, Joseph P., & Gesten, Foster C. (July-August 2004)
Quality oversight and improvement in Medicaid managed care.(Quality Assurance Reporting Requirements ). In Journal of Public Health Management and Practice, 10, p321(9).

6. Wang, Cheng, Villar, Maria Elena, Mulligan, Deborah A., & Hansen, Toran. (Nov 2005) Cost and utilization analysis of a Pediatric Emergency Department Diversion Project. In Pediatrics, 116, p1075(5). Retrieved July 11, 2013, from InfoTrac OneFile via Thomson Gale:

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