Health Care Following Environmental Disasters: Evidence from Flint

• 成果类型: Article
• 署名作者: Danagoulian, Shooshan; Grossman, Daniel; Slusky, David
• 署名单位: Wayne State University; West Virginia University; University of Kansas
• 刊物名称: JOURNAL OF POLICY ANALYSIS AND MANAGEMENT
• ISSN/ISSBN: 1520-7010
• DOI: 10.1002/pam.22391
• 发表日期: 2022
• 页码: 1060-1089
• 关键词: emergency-department visits; blood lead concentrations; act medicaid expansion; 10 mu-g/dl; low-income; water crisis; appointment availability; public insurance; cash incentives; CHILDREN

摘要

Environmental disasters can affect how individuals use healthcare services. We use the Flint water crisis to examine rates of avoidable emergency care, which is costly to both providers and patients, and office visits. In September 2015, the city of Flint issued a lead advisory to its residents, alerting them of increased lead levels in their drinking water, resulting from the switch in water source from Lake Huron to the Flint River. Using Medicaid claims for 2013 to 2016, we find that this advisory, which became national news, increased the share of enrollees who had lead tests performed by 1.7 percentage points. Additionally, it increased office visits immediately, and led to a reduction of 4.9 preventable, non-emergent, and primary-care-treatable emergency room visits per 1,000 eligible children (8.3 percent). This decrease is present in shifts from emergency room visits to office visits across several common conditions. Our analysis suggests that children were more likely to receive care from the same clinic following lead tests and that establishing care reduced the likelihood parents would take their children to emergency rooms for conditions that would have been treatable in an office setting. Our results show that environmental disasters that induce health checkups can prompt individuals to change their type and venue of health care, particularly moving away from emergency departments and toward the office setting.