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The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that Medicare-participating hospitals screen and stabilize all individuals appearing in their emergency departments, regardless of expected compensation. To counter the incentive to prioritize revenue-generating patients, the law also prohibits facilities from delaying care to under-insured individuals. I estimate whether timeliness of emergency care is, in fact, unaffected by payer source as mandated. Using the National Hospital Ambulatory Medical Care Survey, I first examine the direct effect of under-insurance and find that under-insurance is associated with an approximately 6–10 % increase in emergency department wait time. Because of concerns that the effects of under-insurance may be mediated by triage assignment, I subsequently estimate the relationship between under-insurance and triage assignment, using the office hours of general practitioners as an exogenous source of variation in payer source. Instrumental variable results suggest that under-insured patients are inexplicably assigned higher triage scores which are known to lengthen waits. Contrary to the stipulations of EMTALA, discrepancies in timeliness of care do exist. Yet, this noncompliance is not readily apparent; roughly 80 % of the increase in under-insured individuals’ wait times are masked by adjustments to triage scores.
KeywordsHealth regulation Insurance Emergency department Triage Wait time
JEL ClassificationI13 I18
- American Hospital Association. (2012). Trends affecting hospitals and health systems: Utilization and volume (Chap. 3). Retrieved from http://www.aha.org/research/reports/tw/chartbook/2012/table3-3.pdf.
- Bound, J., Jaeger, D. A., & Baker, R. M. (1995). Problems with instrumental variables estimation when the correlation between the instruments and the endogenous explanatory variable is weak. Journal of the American Statistical Association, 90(430), 443–450.Google Scholar
- Flores, C. A., & Flores-Lagunes, A. (2009). Identification and estimation of causal mechanisms and net effects of a treatment under unconfoundedness. SSRN eLibrary.Google Scholar
- Institute of Medicine (U.S.). Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: The National Academies Press.Google Scholar
- Institute of Medicine (U.S.). Committee on the Consequences of Uninsurance. (2002). Care without coverage: Too little, too late. Washington, D.C.: National Academy Press.Google Scholar
- National News Briefs. (1998). Hospitals cannot delay care for insurance O.K. The New York Times. Retrieved from http://www.nytimes.com/1998/11/30/us/national-news-briefs-hospitals-cannot-delay-care-for-insurance-ok.html.
- O’Shea, J. S. (2007). The crisis in hospital emergency departments: Overcoming the burden of federal regulation backgrounder. Washington D.C.: Center for Health Policy Studies.Google Scholar
- Press Ganey Associates. (2010). Emergency department: Patient perspectives on American Health Care. (2010). Pulse Report. South Bend: Press Ganey Associates.Google Scholar
- Resneck, J, Jr, Pletcher, M. J., & Lozano, N. (2004). Medicare, Medicaid, and access to dermatologists: The effect of patient insurance on appointment access and wait times. Journal of the American Academy of Dermatology, 50(1), 85–92. doi: 10.1016/S0190.
- Rice, S. (2011). Don’t die waiting in the ER. Retrieved from http://www.cnn.com/2011/HEALTH/01/13/emergency.room.ep/index.html.
- Roll, K., Stargardt, T., & Schreyogg, J. (2012). Effect of type of insurance and income on waiting time for outpatient care. Geneva Papers on Risk and Insurance: Issues and Practice, 37(4), 609–632. doi: 10.1057/Gpp.2012.6.
- United States General Accounting Office. (June 2001). Emergency Care: EMTALA Implementation and Enforcement Issues. Report to Congressional Committees. Washington, D.C.: United States General Accounting Office.Google Scholar
- U.S. Senate: United States Government Accountability Office. (2009). Hospital Emergency Departments: Crowding continues to occur, and some patients wait longer than recommended time frames. Report to the Chairman, Committee on Finance, U.S. Senate: United States Government Accountability Office.Google Scholar