TennCare disenrollment effects on the Davidson County health care safety net

Janice S Emerson, Tennessee State University


This research project assessed the impact of the mid-2005 TennCare disenrollment on the Davidson County, Tennessee health care safety net. Investigator examined safety net outpatient and community organizations leaders key informant interviews regarding challenges faced and strategies used and recommended in serving the uninsured. Additionally, the study examined the Hospital Discharge Data System for the proportion of ER visits and inpatient hospitalizations for 18 to 64 year olds that were for ambulatory care sensitive conditions (i.e., treatable with primary care) the two and a half years pre and post disenrollment (i.e., 2003 and 2007). The researcher analyzed the change in the odds with logistic regression modeling of the uninsured compared to those with “other” (mostly private) insurance going to the ER or being admitted into the hospital with an ACS condition controlling for sex, age, and race/ethnicity. Results demonstrated a definite negative effect of the disenrollment with the “typical” answer of the key informants being that they saw an increase in challenges serving the uninsured. Additionally, the majority of key informants reported “networking” as their main strategy in meeting the challenges. The HDDS ER and inpatient databases showed very substantial increases from 2003 to 2007 in the uninsured with ACS conditions of 2,707 more ER visits (a 45% increase) and 402 more inpatients (a 59% increase). Logistic regression revealed 26% greater odds of the uninsured ACS ER visits compared to “other” (mostly private) from 2003 to 2007 [Exp(B) = 1506 and 1.770, p < 0.000]. While odds were very high in 2003 and 2007 [i.e., 2.4 times greater, Exp(B) = 2.483 and 2.419, respectively, p < 0.000] of uninsured ACS inpatients compared to “other,” odds were not significantly different between years. The study concludes that the mid-2005 TennCare disenrollment added strain to the Davidson County health care safety net and essentially shifted the financial burden of caring for the increased numbers of uninsured.

Subject Area

Public policy|Health care management

Recommended Citation

Janice S Emerson, "TennCare disenrollment effects on the Davidson County health care safety net" (2010). ETD Collection for Tennessee State University. Paper AAI3404139.