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Healthcare data can reveal interesting insights about the state of our nation, especially when viewed on a local level. Patients in America are a diverse group, and local factors, such as environment, social and economic indicators and policy decisions can shape the ways we seek and access care.

With millions of patients searching for and booking healthcare appointments via Zocdoc each month across 50 types of specialties, we have unique, real-time access to data on different health needs across the country.

Given the public discourse surrounding healthcare legislation, we recently analyzed millions of anonymized patient searches on our platform to understand what types of care might be impacted by changes to existing policy. Specifically, we focused on procedures or visit reasons that are searched for disproportionately in each state, and then looked at those that are included in the ten essential health benefits (EHBs) mandated by the Affordable Care Act.

We wanted to leverage our unique data to understand: which essential health benefit is most disproportionately sought out in each state, and therefore most at risk from changes to policy?

First laid out in the 2010 Affordable Care Act, EHBs are benefits that most health plans are required to cover by law. These fall into ten general categories, including mental health services, maternity care, well-woman visits, preventive care and screenings, prescriptions, and more.

In the latest healthcare bill, states would have the ability to waive EHBs as they see fit. This means that insurers could potentially offer cheaper plans that reduce – or redefine – the essential services currently required to be covered.


Americans are searching for essential health benefits

What’s clear from the map is that, across the country, patients are taking steps to see a doctor for a variety of essential healthcare services. Twenty-nine states and the District of Columbia had an unusually high volume of searches for EHB procedures on Zocdoc.

In the unlabeled states, the visit reasons that showed up as disproportionately popular included illness, eye consultation, surgery consultation and others that were either too general to categorize or may not be covered under EHBs.

Mapping out these searches yields important insights

Any changes to healthcare legislation can profoundly impact patients’ incentives and behaviors. When we look at the currently proposed legislative changes through the lens of EHBs, we gain insight into potential patient impact by state and visit type.

If these benefits are limited or eliminated, patients seeking care for therapy and other treatments for mental illness, maternity and newborn care, early screenings and detection, and well woman visits may be at increased risk. Here are the states with patients disproportionately looking for care in each category:

  • Mental health services

Most ACA plans are required to cover “behavioral disorders, including therapy, medication and preventative measures like depression screenings.” On Zocdoc, mental health services, including psychiatry consultations (the most unusually popular search in nine states), psychotherapy, and treatment for ADD/ADHD, appear most prominently in three pockets: Southeast/Southwest (Oklahoma, Arkansas, Louisiana); upper Midwest (Minnesota, Wisconsin); and upper Southeast (North Carolina, Virginia, West Virginia, Kentucky).

  • Maternity care

Zocdoc patients in Arizona, Georgia and Texas are disproportionately searching for pregnancy-related appointments. Before the ACA, “just 12 percent of individual market plans included maternity benefits,” and pregnancy was considered a pre-existing condition that could disqualify you from coverage.

  • Preventive care and screenings

According to the Kaiser Family Foundation, since the ACA’s passage, “the share of women who delayed or did not get care due to cost is falling.” Today, patients in Florida, Michigan, Nevada, and South Carolina are disproportionately searching for preventive services for women, such as annual pap smear/GYN exam, and in D.C., contraception services in the form of IUD insertion.

Additionally, patients in Connecticut, Massachusetts and New Mexico are disproportionately searching for important preventative care visits, like annual physicals and yearly wellness visits. Research has shown that screenings that take place at these visits often lead to early detection and treatment, and one recent study concludes that “the number of Americans whose cancers were diagnosed at the earliest stage, when it’s most likely to be cured, increased after Obamacare went into effect and more citizens had access to health insurance.”

  • Other EHBs

Patients across many other states are disproportionately searching for other types of EHBs like emergency services, rehabilitative services and visits related to prescriptions/refills.

Here, you can see each state’s most unusually popular essential health benefit. The figures, expressed as percentages, represent how much more likely a patient in a certain state is to search for a procedure, as compared to the national average.

What does this all mean?

According to Brookings, “as the definition of essential health benefits narrows, the scope of the ACA’s guarantee of protection against catastrophic costs shrinks as well. In the absence of any essential health benefit standards at all, these protections would effectively disappear because they would apply to an empty set of health benefits.”

Healthcare decision-making is often described as an exercise in tradeoffs between cost, quality and access. As policymakers and the public wrestle with potential changes to the ACA and the future of our nation’s healthcare, we wanted to broaden access to Zocdoc’s unique, local patient data to help inform how any potential changes stand to impact Americans seeking care.


A note on methodology:

Focusing on the overall most popular searches on the Zocdoc platform would produce pretty uniform results. Instead, we decided to look at the most disproportionately searched procedures/visit reasons in a given area. To do this, we determined the likeliness of a patient in each state to search for a certain procedure, then compared that to the likeliness of the average Zocdoc patient in the U.S. to search for the same procedure. We narrowed our list of procedures to those most likely to be covered under the essential health benefits mandated by the ACA, working with a medical consultant to categorize searched visit reasons into the most appropriate EHB.

The searches we analyzed took place between January 1, 2017 and May 1, 2017, and did not include pediatric visit reasons. Some states did not yield a procedure that was statistically more popular; those are unlabeled or listed as “N/A”.


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