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Universal Health Plan May Not Increase Hospital Care

July 24, 2019

As election season approaches, Medicare-for-all and other universal health plan concepts continue to be discussed at length. Authors of a recent study in Annals of Internal Medicine researched a popular concern that such a plan would cause a surge in patients seeking hospital care and found that that might not be the case.

It is known that individuals with comprehensive health insurance use more hospital care than those who are uninsured or have high deductible plans, explained the study’s abstract. Because of this, many analysts believe that expanding coverage under a universal plan like Medicare-for-all would spike hospital usage and cause a shortage of resources or beds.

Using nationally representative surveys comprising patient data from the 1962 to 1970 National Health Interview Survey, the study’s authors found that hospital discharges averaged 12.8 per 100 people in the three years before implementation of Medicare and Medicaid and 12.7 per 100 people in the three years afterward.

The 2008 to 2015 Medical Expenditure Panel Survey data showed that with the ACA discharges dropped from 9.4 per 100 people in the three years before the law to 9.0 per 100 people in the three years afterward.

“Contrary to expectations, overall hospitalizations didn’t rise after both expansions—suggesting that universal coverage expansions like Medicare-for-all also won’t cause a surge in hospitalizations,” said Adam Gaffney, MD, lead author of the study and president of Physicians for a National Health Program, in a statement.

The study continued, “past coverage expansions were associated with little or no change in society-wide hospital use and increases in groups who gained coverage were offset by reductions among others, suggesting that bed supply limited increases in use.”

“When it comes to prescription drugs, there is no supply limit as there is with hospital beds in the case of hospital care,” Dr Gaffney said in a statement. “So we probably would expect a more unconstrained increase in prescription drug use after Medicare for All, relative to hospital care.”

Overall, Dr Gaffney and colleagues stated that reducing coverage may merely shift care toward wealthier and healthier persons and that universal coverage is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained.

—Edan Stanley


Gaffney A, Mccormick D, Bor DH, et al. The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States [published online July 23, 2019]. Ann Intern Med. doi:10.7326/m18-2806

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