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Before 1986, emergency rooms in the United States routinely turned patients away at the door if they didn’t have insurance. In fact, it was legal to do so. The Emergency Medical Treatment and Active Labor Act (EMTALA), passed that year, looked to stop that practice: The law mandated that hospitals screen and stabilize any patient, regardless of their ability to pay.
While the law has helped cut down on overt refusal of care, gaps in emergency room access persist, according to research published this week in the Journal of the American Medical Association. Uninsured patients or those on Medicaid who come to the emergency department with pulmonary conditions like pneumonia or asthma are more likely to be transferred to another hospital than patients on private insurance, the study found. They are also more likely to be discharged directly from the emergency department than patients with private insurance.
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“One of the things you often hear anecdotally is that patients got transferred—the term they use is ‘dumping’—because of their insurance status,” says study author Arjun Venkatesh, chief of the administration section in the department of emergency Medicine at Yale University School of Medicine. The transfers might not violate EMTALA, but reflect gaps in access. It’s been hard to study the question, he says, because most research on hospitals’ transfers has looked at conditions that require a specialized doctor. In those cases, transfers might have been necessary to get patients to places that can handle a more unique case.
This study, though, looked at asthma, pneumonia, and chronic obstructive pulmonary disease. “They’re bread and butter, and can be...
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