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The Affordable Care Act: Disparities in emergency department use for mental health diagnoses in young adults

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Justin Yanuck1, Bryson Hicks1, Craig Anderson1, John Billimek2, Shahram Lotfipour1, Bharath Chakravarthy1


1 Division of Emergency Medicine, University of California, Irvine, Orange, California 92868, USA


2 Division of General Internal Medicine and Department of Family Medicine, Irvine School of Medicine, Irvine, Orange, California 92868, USA


Corresponding Author: Justin Yanuck, Email: jyanuck@uci.edu


© 2017 World Journal of Emergency Medicine


DOI: 10.5847/wjem.j.1920–8642.2017.03.008


BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department (ED) utilization for mental health purposes. We aimed to study the race specific association between the dependent coverage provision of the Affordable Care Act (ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses.

METHODS: We utilized a Quasi-Experimental analysis of ED use in California from 2009–2011 for behavioral health diagnoses of individuals aged 19 to 31 years. Analysis used a difference-indifferences approach comparing those targeted by the ACA dependent provision (19–25 years) and those who were not (27 to 31 years), evaluating changes in ED visit rates per 1 000 in California. Primary outcomes measured included the quarterly ED visit rates with any psychiatric diagnosis. Subgroups were analyzed for differences based on race and gender.

RESULTS: The ACA dependent provision was associated with 0.05 per 1 000 people fewer psychiatric ED visits among the treatment group (19–25 years) compared to the control group (27–31 years). Hispanics and Asian/Pacific Islanders were the only racial subgroups who did not see this significant reduction and were the only racial subgroups that did not see significant gains in the proportion of psychiatric ED visits covered by private insurance.

CONCLUSION: The ACA dependent provision was associated with a modest reduction in the growth rate of ED use for psychiatric reasons, however, racial disparities in the effect of this provision exist for patients of Hispanic and Asian/Pacific Islander racial groups.

(World J Emerg Med 2017;8(3):206–213)


KEY WORDS: Affordable Care Act; Mental health; Disparities; Health Policy

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