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- Title
Association of Ambulance Use in New York City With the Implementation of the Patient Protection and Affordable Care Act.
- Authors
Courtemanche, Charles; Friedson, Andrew I.; Rees, Daniel I.
- Abstract
This case-control study of emergency medical service dispatch data in New York, New York, examines changes in dispatches of ambulance transports for minor injuries compared with other injuries before and after the implementation of the Patient Protection and Affordable Care Act. Key Points: Question: Was the expansion of insurance coverage under the Patient Protection and Affordable Care Act associated with changes in ambulance service use in New York, New York? Findings: In this case-control study of more than 4.7 million ambulance transports in New York City, from January 1, 2013, to July 31, 2016, the expansion of insurance implemented under the Patient Protect and Affordable Care Act was associated with a statistically significant increase in ambulance dispatches for minor injuries compared with ambulance dispatches for more severe injuries. Meaning: Insurance expansion may be associated with increased use of emergency medical services in nonemergent situations, which the literature suggests may lead to congestion and slower response times. Importance: Expanding insurance coverage may be associated with overuse of medical care because newly insured patients are insulated from having to pay the full cost. Objective: To examine the use of ambulance transport before and after the rollout of the Patient Protection and Affordable Care Act (ACA) in New York City (NYC), New York. Design, Setting, and Participants: In this case-control study, the volume of ambulance dispatches in NYC for minor injuries before and after the rollout of the ACA was examined. Data were drawn from a census of all ambulance dispatches in NYC between January 1, 2013, and July 31, 2016. Ambulance dispatches for more severe injuries, which are more difficult to characterize as unnecessary, were used as the control group. Analyses were conducted from August 17, 2017, to May, 10, 2019. Main Outcome and Measures: The main outcome was the number of ambulance dispatches for minor injuries, defined per month per dispatch zone. The implementation of the ACA was measured using an indicator variable of 1 for dispatches starting January 1, 2014, and 0 for dispatches before January 1, 2014. The number of ambulance dispatches for injuries and major injuries was used to account for secular trends. Injury severity was classified by the dispatchers based on information from the 911 callers with a severity score on a scale of 1 to 8, where 1 is the most severe; minor injuries had a score of 7; injuries, 5; and major injuries, 3. Results: There were 4 787 180 ambulance dispatches in NYC during the study. After the 2014 expansion of insurance coverage under the ACA, there was an increase in ambulance dispatches for minor injuries compared with dispatches for more severe injuries. Compared with the preimplementation mean (SD) of 20.75 (14.24) minor injury dispatches per dispatch zone per month, there were 7.71 (95% CI, 1.23-14.19) additional minor injury dispatches per dispatch zone per month compared with dispatches for other types of injuries, an increase of 37.2%. Given that NYC has 31 dispatch zones, this increase is equivalent to approximately 239 additional dispatches per month or 2868 additional dispatches per year for minor injuries. Conclusions and Relevance: There was a significant increase in use of ambulance transport for minor injuries in NYC after the ACA insurance expansion, suggesting that the change in health insurance structure was associated with increased use of emergency medical services in nonemergent situations. Future reforms to the US health insurance system should take into account the potential for increased use of emergency medical services in nonemergent situations, which the literature suggests may lead to congestion and slower response times.
- Subjects
NEW York (State); AMBULANCES; CONFIDENCE intervals; EMERGENCY medical services; INSURANCE; REGRESSION analysis; CASE-control method; DATA analysis software; PATIENT Protection &; Affordable Care Act
- Publication
JAMA Network Open, 2019, Vol 2, Issue 6, pe196419
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2019.6419