Overall emergency room visits rose but low-severity visits dropped after Massachusetts enacted healthcare reform, researchers say. Lead author Dr. Peter Smulowitz, an emergency physician at Beth Israel Deaconess Medical Center in Boston, and colleagues examined administrative billing data from 11 hospitals from 2006 to 2008 -- the year before and two years after implementation of the Massachusetts law providing healthcare access. The combined emergency departments had about 587,000 visits, or about 20 percent of all emergency visits in Massachusetts. Researchers found a 4.1 percent increase in overall emergency room visits from 2006 to 2008, 3.4 percent from 2006 to 2007 and 0.7 percent the following year. They found a 1.8 percent decrease in low-severity visits for the group affected by the reform law vs. the comparison group. The small decrease in low-severity visits was somewhat contradictory to expectations prior to the reform, Smulowitz says. The study, published in the Annals of Emergency Medicine, suggests the lack of availability of primary care physicians in Massachusetts may be a key reason for the limited effect of health reform. In addition, low or non-existent co-payments for the MassHealth and Commonwealth Care public healthcare plans may also be factors. \"In addition, it might take time and effort to alter care-seeking patterns that have become ingrained in some communities,\" Smulowitz says in a statement. \"Many of these patients had never had insurance before, so they may have been relying on the emergency department instead of other care settings.\"