By 2016, two years into the expansion of the Affordable Care Act, 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 such as abrasions, minor burns and muscle sprains rose by 37% in New York City.
That runs counter to the expectation that expansion would get people out of emergency rooms. But in New York at least, larger enrollment has led more utilization of emergency care.
The findings of the study were published in JAMA Network Open.
WHAT'S THE IMPACT
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, 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 the ACA to 28.46 in the years following. The increase is equivalent to about 239 additional dispatches a month -- or 2,868 per year -- for minor injuries.
Part of the reason for the increase may be explained by the fact that ambulances are now cheaper than Uber. Typically, when Uber shows up in a city, the usage of ambulance services drops 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, the researchers contended, they will be more likely to use an ambulance for medical transportation in less emergent situations.
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.
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. New York -- 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, researchers said.
THE LARGER TREND
The JAMA study is among the first to examine ambulance usage specifically; most research to date has focused on Medicaid expansion. While not without its hiccups, news of the effects of the ACA's Medicaid expansion has leaned positive, particularly for previously uninsured Americans. Just last week, a study published in Medical Care Research and Review found that newly insured patients may be relying more on outpatient care for less severe conditions, affecting utilization by avoiding unnecessary ED visits -- effectively freeing up hospital EDs for their intended purpose.
The JAMA study is among the first to suggest that utilization may be negatively affected in other ways.