Abstract
Emergency medical services (EMS) are an essential component of the health care system, but the effect of insurance expansion on EMS call volume remains unclear. This study investigated the association between health insurance expansion and EMS dispatches for asthma, an ambulatory care-sensitive condition. We hypothesized that insurance expansion under the Patient Protection and Affordable Care Act (ACA) would be associated with decreased EMS dispatches for asthma emergencies. This cohort study examined 14 865 267 ambulance calls dispatched within New York City from 2008 to 2018, including 217 303 calls for asthma-related emergencies, and used interrupted time series analysis to study the change in the annual incidence of EMS dispatches for asthma emergencies after implementation of the ACA. Multivariable linear regression examined the association between the uninsured rate and the incidence of asthma-related dispatches, controlling for population demographic characteristics and air quality index. Implementation of ACA on January 1, 2014. Incidence of EMS dispatches for asthma emergencies per 100 000 population per year (ie, asthma EMS dispatch rate) as classified by the 911 call-taker. In this study of 217 303 EMS dispatches for asthma-related emergencies, there was a decrease in the asthma EMS dispatch rate after implementation of the ACA, from a mean (SD) of 261 (24) dispatches per 100 000 population per year preintervention to 211 (47) postintervention (P = .047). This decrease in asthma EMS dispatch rate after ACA implementation was significant on interrupted time series analysis. Prior to 2014, the annual asthma EMS dispatch rate was increasing by 11.8 calls per 100 000 population per year (95% CI, 6.1 to 17.4). After ACA implementation, the asthma EMS dispatch rate decreased annually by 28.5 calls per 100 000 population per year (95% CI, -37.6 to -19.3), a significant change in slope from the preintervention period (P < .001). Multivariable linear regression, controlling for percentage of individuals younger than age 18 years, degree of racial/ethnic diversity, median household income, and air quality index, found that a 1% decrease in the citywide uninsured rate was associated with a decrease of 98.9 asthma dispatches per 100 000 population per year (95% CI, 5.72-192.10; P = .04). Insurance expansion within New York City under the ACA was associated with a significant reduction in the asthma EMS dispatch rate. Insurance expansion may be a viable method to reduce EMS utilization for ambulatory care-sensitive conditions such as asthma.
Highlights
Emergency medical services (EMS) in the US respond to millions of calls each year,[1] delivering prehospital care to patients with conditions ranging from life-threatening emergencies to minor injuries
Prior to 2014, the annual asthma EMS dispatch rate was increasing by 11.8 calls per 100 000 population per year
After Affordable Care Act (ACA) implementation, the asthma EMS dispatch rate decreased annually by 28.5 calls per 100 000 population per year, a significant change in slope from the preintervention period (P < .001)
Summary
Emergency medical services (EMS) in the US respond to millions of calls each year,[1] delivering prehospital care to patients with conditions ranging from life-threatening emergencies to minor injuries. Prior studies of the effects of health insurance expansion on emergency services utilization have yielded conflicting results.[6] Insurance expansion, including through the 2014 implementation of the Patient Protection and Affordable Care Act (ACA), was shown in some studies to increase the number of visits to emergency departments.[7,8,9] ACA implementation was associated with an increase in EMS utilization for minor injuries in New York City (NYC).[10] other studies[11,12,13,14] have demonstrated no change after insurance expansion or even a decrease in utilization of emergency services. Asthma has been extensively studied as an example of an ambulatory care–sensitive condition, and lack of insurance is a risk factor for developing asthma exacerbations that require emergency care.[16,17,18,19] it is unknown whether EMS utilization for ambulatory care–sensitive conditions would decrease due to the assumed improvement in primary care management related to insurance expansion
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