Emergency Department Visit Reduction Programs: Practice, Evidence, and Policy Context

Investigator: Andrew B. Bindman, MD
Sponsor: HHS Medicaid and CHIP Payment and Access Commission (MACPAC)

Location(s): United States


The Medicaid and CHIP Payment Advisory Commission (MACPAC), is the body charged with reviewing state and federal Medicaid and CHIP (Children’s Health Insurance Plan) access and payment policies and making recommendations to Congress, the Secretary of Health and Human Services (HHS) and the states. 
Emergency department (ED) use is an ongoing concern to MACPAC, State Medicaid programs, and policy makers. Concern about ED use arises for two main reasons. First, research has shown that some portion of ED visits could be avoided with appropriate care in a primary care setting. Second, the emergency department is considered a more costly setting in which to provide care for certain conditions that could be treated elsewhere. How people use emergency departments can be influenced by the availability of their primary care physicians, their access to specialty care, the quality of that care, cost sharing requirements, and their own personal experiences.