Does the emergency medical treatment and labor act affect emergency department use?

William M. McDonnell, Christopher A. Gee, Nancy Mecham, Jessica Dahl-Olsen, Elisabeth Guenther

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Emergency departments (EDs) face increasing patient volumes and economic pressures. These problems have been attributed to the Emergency Medical Treatment and Labor Act (EMTALA). Study objective: To determine whether modifying EMTALA might reduce ED use. Methods: We surveyed ED patients to assess their knowledge of hospitals' obligations to treat all patients regardless of insurance and to determine whether knowledge is associated with ED use. Results: Among 4136 study subjects, 72% reported awareness of the law. Sixty-one percent of subjects were moderate ED users (≥ 1 additional ED visit in 12 months). Moderate users more often knew the law (74% vs. 70%, p = 0.005). Multivariate regression showed that factors associated with moderate use were: Awareness of EMTALA (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.24-1.67), adult patient (OR 1.94; 95% CI 1.69-2.22), and government insurance (OR 2.67; 95% CI 2.30-3.08) or uninsured (OR 1.72; 95% CI 1.42-2.08). Only 8% of subjects were high-frequency users (≥5 visits). High-frequency users were more often aware of EMTALA (78% vs. 72%, p = 0.02). Covariates associated with high frequency were EMTALA awareness (OR 1.69; 95% CI 1.28-2.24), adult patient (OR 2.59; 95% CI 2.00-3.36), and government insurance (OR 3.73; 95% CI 2.76-5.06) or uninsured (OR 3.77; 95% CI 2.65-5.35). Conclusion: Many patients know that the law requires hospitals to provide care. This knowledge is associated with more frequent ED use. EMTALA changes might reduce ED use, but broader policy implications should be considered.

Original languageEnglish (US)
Pages (from-to)209-216
Number of pages8
JournalJournal of Emergency Medicine
Volume44
Issue number1
DOIs
StatePublished - Jan 1 2013

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Emergency Treatment
Hospital Emergency Service
Odds Ratio
Confidence Intervals
Insurance
Economics
Pressure

Keywords

  • emergency department crowding
  • emergency department utilization
  • emergency medical treatment and labor act
  • health care policy
  • health care regulation

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Does the emergency medical treatment and labor act affect emergency department use? / McDonnell, William M.; Gee, Christopher A.; Mecham, Nancy; Dahl-Olsen, Jessica; Guenther, Elisabeth.

In: Journal of Emergency Medicine, Vol. 44, No. 1, 01.01.2013, p. 209-216.

Research output: Contribution to journalArticle

McDonnell, William M. ; Gee, Christopher A. ; Mecham, Nancy ; Dahl-Olsen, Jessica ; Guenther, Elisabeth. / Does the emergency medical treatment and labor act affect emergency department use?. In: Journal of Emergency Medicine. 2013 ; Vol. 44, No. 1. pp. 209-216.
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abstract = "Background: Emergency departments (EDs) face increasing patient volumes and economic pressures. These problems have been attributed to the Emergency Medical Treatment and Labor Act (EMTALA). Study objective: To determine whether modifying EMTALA might reduce ED use. Methods: We surveyed ED patients to assess their knowledge of hospitals' obligations to treat all patients regardless of insurance and to determine whether knowledge is associated with ED use. Results: Among 4136 study subjects, 72{\%} reported awareness of the law. Sixty-one percent of subjects were moderate ED users (≥ 1 additional ED visit in 12 months). Moderate users more often knew the law (74{\%} vs. 70{\%}, p = 0.005). Multivariate regression showed that factors associated with moderate use were: Awareness of EMTALA (odds ratio [OR] 1.44; 95{\%} confidence interval [CI] 1.24-1.67), adult patient (OR 1.94; 95{\%} CI 1.69-2.22), and government insurance (OR 2.67; 95{\%} CI 2.30-3.08) or uninsured (OR 1.72; 95{\%} CI 1.42-2.08). Only 8{\%} of subjects were high-frequency users (≥5 visits). High-frequency users were more often aware of EMTALA (78{\%} vs. 72{\%}, p = 0.02). Covariates associated with high frequency were EMTALA awareness (OR 1.69; 95{\%} CI 1.28-2.24), adult patient (OR 2.59; 95{\%} CI 2.00-3.36), and government insurance (OR 3.73; 95{\%} CI 2.76-5.06) or uninsured (OR 3.77; 95{\%} CI 2.65-5.35). Conclusion: Many patients know that the law requires hospitals to provide care. This knowledge is associated with more frequent ED use. EMTALA changes might reduce ED use, but broader policy implications should be considered.",
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