By 2016, two years after the extension of the Affordable Care Act (ACA), 17.6 million previously uninsured people in the US had received health insurance coverage. With the expansion, researchers from the University of Colorado Denver and the University of Kentucky found that the number of ambulance transports for minor injuries such as abrasions, minor burns and muscle sprain increased by a staggering 37% in New York City.
the assumption that the extension would bring people out of the emergency rooms. Few people thought a larger number of participants would lead to greater use of emergency care, since an emergency is an emergency. Insurance should no longer mean an emergency.
Andrew Friedson, PhD, assistant professor of economics at CU Denver
The findings are described today in JAMA Network Open in a study by Friedson and Dr. Daniel Rees, a professor of economics at the University of Kentucky, Denver, and Dr. Charles Courtemanche, Professor of Economics at the University of Kentucky Dispatches in New York City between January 1
In the years before and after the ACA, shipments of serious injuries (such as chest pain, composite fractures and unconsciousness) were relatively similar, but shipments of minor injuries increased 37.2%. from an average of 20.75 shipments per shipping zone per month before ACA to 28.46 in the following years. The increase is equivalent to about 239 additional shipments per month – or 2,868 per year – for minor injuries.
"I had expected an increase below 5%, the size of the dressing was surprising," says Friedson.
] Ambulances Are Now Cheaper Than Uber
Earlier research has shown that the use of emergency services declines when Uber turns up in a city. With the expansion of the ACA, ambulance expenses have fallen for many people. If patients bear a lesser portion of the costs, they are more likely to use an ambulance to transport sick people in less urgent situations, researchers say.
"Medicaid patients in particular have incredibly little responsibility for ambulance out of pocket," says Friedson. "An ambulance ride covered by Medicaid costs the patient no more than $ 3. If there's a cost-effective alternative to getting Uber to the hospital, you'll take it."
As a result, medically unnecessary trips can contribute to the congestion of cities, slow down the response time to actual emergencies, and increase the risk of death for people in emergency situations.
Health policy needs better guard rails
"At the time of the adoption of the ACA, policymakers might not have had sufficient safety and health care ambulances," says Friedson. "One solution would have been to give the law more nuances – it had to be made clear that ambulances are covered as long as you reach a certain level of severity, and if not, additional measures will be needed." Cost sharing. Or, if you do not want to make these findings because they are difficult to reach, policymakers would have been able to raise money for the development of the emergency system. "Triage call centers to make emergency calls and divert these patients away from ambulances NYC – and most US cities – are not yet doing so, but as scratching and spraining attempts bind rescue workers, this may change soon.
University of Colorado Denver
Reference:  Friedson, A. et al. . (2019) Association of Ambulance Use in New York City with the implementation of the Act on Patient Protection and Affordable Care. JAMA Network Open . doi.org/10.1001/jamanetworkopen.2019.6419.