TennCare Disenrollment and Avoidable Hospital Visits in Davidson County, Tennessee

The objective of this study was to determine if an association existed between the mid-2005 TennCare (Medicaid) disenrollment and increases in uninsured ambulatory care sensitive condition (ACSC) non-admitted ER visits and inpatient hospitalizations in Davidson County, Tennessee (= the city of Nashville). Logistic regression modeling, using an interactive term for insurance category x year, indicated that the effect of no insurance on ACSC ER visits increased by 18% from 2003 to 2007 (p<.001), but no significant effect was found for uninsured ACSC inpatient hospitalizations. These greater odds of ACSC ER visits among uninsured patients were associated with a 60% increase in hospitals’ bad debt write offs during this same time period. Therefore, the TennCare disenrollment was associated with increased likelihood of uninsured ACSC non-admitted ER visits and greater financial losses for Davidson County hospitals during this time period.