Ambulance journeys increased by 37% among city dwellers after the expansion of Medicaid, the study finds

Unnecessary ambulance journeys rose in New York City after government-subsidized insurance was expanded under the Affordable Care Act (ACA), according to a new study.


Trips for minor injuries increased by more than 37 percent as soon as the ACA had made required insurers – public and private – to provide more coverage for ambulance transport, and made more people eligible for Medicaid.

Public health experts expected that after enlargement more people would start using health care – but the measure was not intended to increase the use of emergency services for minor injuries and illnesses.

The authors of the study say that a Medicaid patient is only responsible for $ 3 of an ambulance, but the services themselves are expensive and can become an exaggerated burden on government health care costs.

However, doctors in New York claim that the increase demonstrates that the program meets the needs of low-income New Yorkers who do not have a car to drive to the hospital.

And according to them, excessive use of ambulance services is a small price that people have to pay to receive medical treatment.

Since Medicaid was expanded with the Affordable Care Act, the number of residents of New York City using ambulances has increased by 37% in 2014, a graph of the new study.


Since Medicaid was expanded with the Affordable Care Act, the number of residents of New York City using ambulances has increased by 37% in 2014, a graph of the new study.

Former President Obama's Patient Protection and Affordable Care Act entered into force in January 2014 and included funding to support more people with Medicaid, the government-subsidized insurance program for low-income Americans.

Throughout the country, the insurance enrollment rate has since increased by more than 27 percent.

States may choose whether they want to opt for enlargement, and New York did so immediately.

Since the state of Medicaid has expanded, enrollment has grown by 14 percent (from the latest data, updated in July of last year).

The proportion of residents of New York City without insurance has fallen steadily since 2014 and is expected to fall to less than 9.5 percent of the city population this year.

Medicaid covers inpatient and outpatient treatment, preventive and annual wellness care, screening and, indeed, transport.


For people without insurance or even people with private insurance, who often do not cover ambulance transport, it can be very expensive to go to the hospital.

At the baseline, an ambulance costs an average of $ 400 to $ 1,200, with costs per kilometer being maintained, according to Cost Helper.

But according to the ACA, insurers now have to cover part of those costs for their customers.

Going to the hospital is particularly a problem in New York City, where very few people – especially those who are eligible for Medicaid – can or can afford cars to drive to the hospital.

Many residents of New York City resort to taking Uber or Lyft cars to the hospital – a practice that was even supported by a study from Harvard University.


But there is some debate about what justifies an ambulance ride, and who has to bear the costs of going to a hospital.

The authors of the CU Denver study are concerned that & # 39; increase in ambulance broadcasts for less serious injuries compared to those for other types of injuries in NYC after the implementation of the ACA in 2014 could be related to patients who were not have to pay full costs & # 39 ;, they write.

The authors are also concerned that waiting times for emergency medical emergencies that can lead to life-threatening events are that these increases were seen for minor injuries, such as ankle sprains.

Co-author of the study, Dr. Andrew Friedson, an economics professor at the CU in Denver, says he has heard from doctors that their emergency departments are becoming increasingly overburdened, meaning that all patients have to wait longer to be seen.

& # 39; Congestion one of the classic problems of cities and emergency care & # 39 ;, he told


In his opinion, the ACA itself is not the issue, but congestion is a symptom of giving a very generous insurance policy and we know that it ensures that people like to consume more (health services).

& # 39; Usually these are things they really, really need and can pay now, but it can also mean things they don't really need, such as ambulance trips for minor injuries. & # 39;

But in an accompanying editorial, two doctors from New York City were dissolving.

They note that the increase was significant, but that only one percent of the ambulance is sent from the period the researchers looked – between 2013 and the first half of 2016 – were for & # 39; minor injuries & # 39 ;.

& # 39; In addition, there is evidence that cost exchange can be effective as a means of reducing healthcare costs, but this is at the expense of both necessary and unnecessary care, & # 39 ;, they write.


& # 39; Patients can be cost-conscious, but often at the expense of the required healthcare. & # 39;

They also underline the unique circumstances of New York City, where most residents depend on public transportation, which may be too slow or physically impossible for someone with an injury.

& # 39; Transport can be an obstacle to access to healthcare, and in NYC in particular, people with a lower income feel a greater burden & # 39 ;, they write.

& # 39; Owning a car and having access to affordable parking is not feasible for most (including many doctors) and public transportation is limited.

& # 39; Some clinics are far from the nearest public transportation stops. Metro's and buses are often overcrowded and slow, and for patients with weakness, these services can feel particularly unwelcome in times of need; any alternative to that certainly seems more attractive. & # 39;

Dr. Friedson is currently working on a research project that shows that the number of ambulances is increasing and the volume of ambulance services is 9-1-1, but he admits that if there were any results that the results were poor would it be in NYC. & # 39;

He added a wink to the editors' comments that & # 39; ambulance congestion is bad, but transport in general is poor & # 39; in New York City.

Dr. Friedson said the use of ambulances for minor injuries & # 39; a problem & # 39; is, although he thinks this can be solved, but not by an economist like himself.

& # 39; I don't think it's a problem with the ACA, but it's an insurance issue, & # 39; he said.

& # 39; To some extent, there are ways to take and eat your cake, but insurers and policy makers may need a finer-combed comb to triage incoming patients and cost sharing.


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