Working Paper: NBER ID: w27098
Authors: Shooshan Danagoulian; Daniel S. Grossman; David Slusky
Abstract: Emergency department visits are costly to providers and to patients. We use the Flint water crisis to test if an increase in office visits reduced avoidable emergency room 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 2013-2016, we find that this information shock increased the share of enrollees who had lead tests performed by 1.7 percentage points. Additionally, it increased office visits immediately following the information shock and led to a reduction of 4.9 preventable, non-emergent, and primary-care-treatable emergency room visits per 1000 eligible children (8.2%). This decrease is present in shifts from emergency room visits to office visits across several common conditions. Our analysis suggest 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 treatable in an office setting. Our results are potentially applicable to any situation in which individuals are induced to seek more care in an office visit setting.
Keywords: Flint water crisis; emergency department visits; primary care; lead exposure; healthcare utilization
JEL Codes: H75; I12; I18; J13; Q53; Q58
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Lead advisory issued in September 2015 (L74) | Increased share of Medicaid enrollees in Flint who received lead tests (I18) |
| Lead advisory issued in September 2015 (L74) | Increased share of enrollees who had any office visit (I11) |
| Increased share of enrollees who had any office visit (I11) | Reduction of preventable non-emergent and primary care treatable ED visits (I11) |
| Lead advisory issued in September 2015 (L74) | Shift in care from EDs to primary care settings (I11) |
| Children who received lead tests (I24) | More likely to return to the clinic for follow-up care (I11) |