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Health, Systems, and Policy Research

Emergency department and inpatient utilization among U.S. older adults with multiple chronic conditions: a post-reform update

SangNam Ahn, PhD, MSPA

BMC Health Services Research, volume 20, Article number: 77 (2020)

Older Medicare beneficiaries with multiple chronic conditions increased emergency department (ED) visits but decreased inpatient utilization throughout the course of the Affordable Care Act (ACA), according to a study published in BMC Health Services Research.

Dr. SangNam Ahn, University of Memphis School of Public Health, led the study with other researchers including Dr. Mustafa Hussein of University of Wisconsin—Milwaukee, Dr. Asos Mahmood of University of Memphis School of Public Health, and Dr. Matthew Lee Smith of Texas A&M School of Public Health.

The Affordable Care Act was enacted to improve access to care primarily among nonelderly and low-income populations; however, there were several key provisions to address determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years.

In the current study, the researchers wanted to take stack of the overall changes in ED and inpatient visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update.

The team of investigators found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs.

The study findings underscore the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

 

Adverse Childhood Experiences

SangNam Ahn, PhD, MSPA

Dr. Ahn investigates the moderating roles of social support in the deleterious effect of multiple chronic conditions on late-life depression, as well as the devastating effect of adverse childhood experiences (ACEs) on childhood obesity. Click here for a complete description, here for the research poster, and here for access to the full research paper.

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Associations of the COVID-19 pandemic with older individuals’ healthcare utilization and self-reported health status: a longitudinal analysis from Singapore

SangNam Ahn, PhD, MSPA

BMC Health Services Research, volume 22, Article number: 66 (2022)

Between January and April 2020 (the first peak period of COVID-19 in Singapore), doctor visits decreased by 30%, and out-of-pocket medical spending decreased by 23%, mostly driven by reductions in inpatient and outpatient care. As a result, the probability of any diagnosis of chronic conditions decreased by 19% in April 2020. The decreased healthcare utilization and spending recovered after lifting the national lockdown in June, 2020 and remained similar to the pre-pandemic level through the rest of 2020.

Dr. SangNam Ahn, University of Memphis School of Public Health, led the study with other researchers including Dr. Seonghoon Kim of Singapore Management University and Dr. Kanghyock Koh of Korea University.

Previous studies have mainly documented snapshots of healthcare utilization and perceived health status in the midst of the pandemic. To extend the literature, the team of investigators provide comprehensive evidence on the changes in healthcare utilization, healthcare spending, and perceived health status among older Singapore residents during the COVID-19 pandemic using the individual-level monthly panel data.

The current study provides a unique perspective related to changes in healthcare utilization, healthcare spending, and perceived health status among older adults during the COVID-19 pandemic. The study findings have the following implications. First, government-imposed restrictions should be carefully implemented to avoid interrupting “essential” healthcare services among non-COVID–19 patients. Second, as the pandemic is prolonged, governments should continue monitoring the long-term health effects of non-COVID–19 patients, especially those who have existing health conditions and delayed healthcare visits. Although the current study finds no evidence of short-term health impact, it is possible that adverse health consequences of delayed healthcare visits emerge later. Lastly, patients should be “activated” to self-care for their chronic conditions, especially older adults with multiple chronic conditions, as their access to healthcare can continue to be limited until the pandemic is over.