A multi-institution study led by researchers at the Perelman School of Medicine at the University of Pennsylvania has found that increasing the number of insured patients is not associated with higher intensive care unit (ICU) usage in Massachusetts. 

Because ICU care is expensive, concerns have been raised that increasing the number of insured patients would inevitably lead to significantly higher health care costs as more of these newly insured patients would be admitted to ICUs.

The Penn-led study, to be published in the November 25 issue of Critical Care Medicine, found that while Massachusetts health insurance reform resulted in a significant reduction in the number of critically ill patients without health insurance (from 9.3 percent to 5.1 percent), there was no concomitant increase in ICU utilization as measured by ICU admissions per capita or ICU admissions per hospitalization.

The findings have potential implications for the nation as a whole since the Affordable Care Act (ACA) -- “health care reform” or “Obamacare” -- expands access to health insurance through several provisions modeled after the health insurance reform enacted by Massachusetts in July 2006. For example, Massachusetts health insurance reform required all adults to purchase health insurance by July 1, 2007.

This patient population stems beyond those who are directly admitted to the ICU. Many patients who have been admitted to a less intense level of care for other illnesses require subsequent ICU stays, as well as following elective procedures, including some cardiac and endovascular operations and cancer surgeries.

The study examined hospital discharge records of patients aged 18-64, comparing ICU utilization in Massachusetts to four states that did not enact health insurance reform: New York, Washington, Nebraska, and North Carolina. The comparison states were chosen because they overlap Massachusetts in population demographics while also being broadly representative of the United States as a whole.

In addition to discovering no significant changes in adjusted ICU admission rates, the study found no significant changes in discharge destination e.g., to a nursing home, or in-hospital ICU-patient mortality rates between Massachusetts and the non-reform states (although this latter association was dependent on the comparison states chosen in the analysis.)

“Greater access to care allows for better preventive care, which may reduce ICU admissions and ultimately an individual’s risk of death in the ICU,” said Sarah M. Lyon, MD, MSCE, a pulmonary medicine specialist in the division of Pulmonary, Allergy and Critical Care at the Hospital of the University of Pennsylvania and the study’s lead author. “Individuals with insurance may also be more likely to come to us earlier in the course of their illness when their acute illness severity is lower.”

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