Medically unnecessary ambulance rides soar after ACA expansion

Science Daily ^ | June 28, 2019 | University of Colorado Denver

[ConservativeMind]

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.

Dispatches to minor injuries jumped 37%

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

"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."

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.

[ChildOfThe60s]

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

Surprising only to a pointy headed academic who has no association with common sense and the real world

[Lurker]

“”Few people thought a larger enrollment would lead to a larger utilization of emergency care,“

Few “experts”, maybe. But those of us with half a fricking brain in our hearts knew exactly what would happen.

L

[sheana]

Hubby worked in a town about 10 miles away from the bigger city where the hospitals were. The town is 98% Hispanic. A lot of illegals. They would use the ambulance for a ‘ride into town’.

[Grampa Dave]

“why drs get away with the preposterous number of tests and drugs prescribed the elderly for what turns out to be arthiritic pain IMO warrants an investigation.....”

A major cause of the above are the local medical societies/hospital boards and state medical boards requiring/mandating/shaming doctors into doing tests on the elderly (over 65). Then, when the test results fall out of the so called norms, like quote pre diabetes, or too much so called fat in our bodies, a little increase in BP or pulse rate due to White Coat aversion and liver function tests or whatever.

Then, the doctor must put us on dangerous drugs and expensive lab tests and office visits for the rest of our lives. Or he/she could be sued and chased out of the medical society for bad practice.

When our FP for forty years retired. Our new FP was a fanatic about fat levels and basically put everyone on a fat lowering drug. I refused based on my age, over 75 and a family history of no heart attacks/disease of anyone under 75. The indication for using the statins was supposedly preventing early heart attacks.

Finally, one day I asked him what patients with so called high fat would not be put on a statin drug.

He said, “Anyone who had a muscle problem with the statins and onset of sleep problems and possible depression.”

I had him give me an rx for the lowest dose statin drug. I had the rx filled that day.

Amazingly, in a week I had all the problems he warned me about, and he told me to stop taking the drug.

For the next 2 years, I still had to have the lab tests, and he would say “Too bad you can’t take even a low dose statin!”

Then, he moved on in the exam. We both just grinned at each other.

He solved the White Coat high bp problem by having my wife, an RN take my bp’s a couple of times a day and recording the results for a month on a special sheet that showed his name and address, my name and month, day and the daily results.

I dropped the first month’s normal results off at his front desk, and the receptionist made a copy of it and entered it electronically into my record. Then, she gave the original back to me and told me to have my wife take and record my bp 2 times a week.

Then, 4 weeks before my next office visit, we would repeat the process. They entered that data showing no high BP into my electronic record.