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.
The findings are describe 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. The authors analyzed data from all of the 911 ambulance dispatches in New York City between January 1, 2013, and July 31, 2016.
The Ambulance dispatches
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) remain 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; so a month or 2,868 per year for minor injuries. They was expecting to find an increase under 5%. The size of the association was surprising, says Friedson.
Previous research found that when Uber shows up in a city; so 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.
Medically unnecessary rides
Medicaid patients in particular have incredibly low; so 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; so slow response time to actual emergencies and increase the risk of death for those in dire situations.
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 to give the law more nuance; it need to spell out that if you’re going to take an ambulance; so you’re cover 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; so because they are difficult to make, policymakers; so could have include 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; also 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.