Nav: Home

Medically unnecessary ambulance rides soar after ACA expansion

June 28, 2019

By 2016, two years into the expansion of the Affordable Care Act (ACA), 17.6 million previously uninsured people around the U.S. had gained health insurance coverage. But with the expansion, researchers at the University of Colorado Denver and the University of Kentucky found that ambulance dispatches for minor injuries like abrasions, minor burns and muscle sprains rose by a staggering 37% in New York City.

"Policymakers were operating under the assumption that the expansion was going to get people out of emergency rooms," says Andrew Friedson, PhD, assistant professor of economics at CU Denver. "Few people thought a larger enrollment would lead to a larger utilization of emergency care, because an emergency is an emergency. Insurance shouldn't make anything more of an emergency."

The findings are described today in JAMA Network Open, in a study by Friedson, along with CU Denver Professor of Economics Daniel Rees, PhD, and University of Kentucky Associate Professor of Economics Charles Courtemanche, PhD.

Dispatches to minor injuries jumped 37%

The authors analyzed data from all of the 911 ambulance dispatches in New York City between January 1, 2013, and July 31, 2016. In New York City, 911 calls are routed through a central dispatch to a trained EMS dispatcher, who triages the call based on type and severity of injury, alerting ambulances in one of the city's 31 zones.

In the years before and after the ACA, dispatches to more severe injuries (such as chest pain, compound fractures and unconsciousness) remained relatively the same. But dispatches to minor injuries leapt 37.2%, from an average of 20.75 dispatches per dispatch zone per month before ACA to 28.46 in the years following. The increase is equivalent to approximately 239 additional dispatches a month - or 2,868 per year - for minor injuries.

"I was expecting to find an increase under 5%. The size of the association was surprising," says Friedson.

Ambulances are now cheaper than Uber

Previous research found that when Uber shows up in a city, the usage of ambulance services drop off. With the expansion of the ACA, the out-of-pocket cost of ambulances tumbled for many people. When patients bear a smaller portion of the cost, researchers argue, they will be more likely to use an ambulance for medical transportation in less emergent situations.

"Medicaid patients in particular have incredibly low out-of-pocket responsibility for ambulances," says Friedson. "The most an ambulance ride covered under Medicaid costs the patient three dollars. If there's a low-cost alternative to Uber to get the hospital, you're going to take it."

As a result, the medically unnecessary rides may add to city congestion, slow response time to actual emergencies and increase the risk of death for those in dire situations.

Health care policy needs better guardrails

"When the ACA was enacted, policymakers may not have had sufficient guardrails in place with regards to emergency care or ambulance utilization," says Friedson. "One solution would have been to give the law more nuance; it needed to spell out that if you're going to take an ambulance, you're covered as long as you meet a certain acuity level. If not, it will involve additional cost-sharing. Or, if you don't want to make those determinations, because they are difficult to make, policymakers could have included money for expanding the emergency response system."

A handful of major U.S. cities are implementing 911 nurse triage call centers to address non-emergency calls and redirect those patients away from ambulances. NYC - and most U.S. cities - don't do that yet, but as dispatches for scrapes and sprains tie up emergency responders, that may soon change.
-end-


University of Colorado Denver

Related Affordable Care Act Articles:

Affordable Care Act slashed the uninsured rate among people with diabetes
The Affordable Care Act (ACA) provided health insurance for an estimated 1.9 million people with diabetes, according to a newly published study.
Many still uninsured after Affordable Care Act Implementation
In community health centers in Medicaid expansion states, among established patients who were uninsured prior to the Affordable Care Act, many remained uninsured after implementation of the Obama-era law.
Nonphysician practitioners absorbing more new patient requests post Affordable Care Act
The advent of the Affordable Care Act has led to millions of new patients seeking primary care.
Fewer people died from heart disease in states that expanded Medicaid coverage through the Affordable Care Act
Counties in states that expanded Medicaid coverage under the Affordable Care Act had fewer deaths annually from heart disease compared to areas that did not expand Medicaid, according to preliminary research presented at the American Heart Association's Quality of Care and Outcomes Research Scientific Sessions 2019.
Affordable Care Act delivers significant benefits for women
According to a new study appearing in the American Journal of Preventive Medicine, published by Elsevier, the rate of health insurance coverage and access to affordable acute and preventive care services improved for women after the implementation of the Affordable Care Act (ACA).
More Affordable Care Act News and Affordable Care Act Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...