Are hospitals using ambulance diversion to avoid certain patients?

Private hospitals may use ambulance diversion as a way to avoid treating uninsured or Medicaid patients, study finds

Charleen Hsuan, assistant professor, health policy and administration, served as lead author on the study, “Ambulance diversions following public hospital department closures.” The study examines whether hospitals are more likely to temporarily close their emergency department to ambulances through ambulance diversion if neighboring diverting hospitals are public vs. private. Emergency departments use ambulance diversions as a way to reduce long patient waits if they are overcrowded. But, might private hospitals be using diversion as a way to avoid uninsured or Medicaid patients?

The idea for the study came from a conversation Hsuan had with an emergency physician at a public hospital who shared that every time the hospital called for an ambulance diversion, hospitals surrounding the area would also call for one. Hsuan wanted to find out what predictors may come in to play for multiple hospitals to declare a diversion at the same time.

The researchers used 2007 California data for their study – examining only complete hospital diversions. The sample study includes 28 private hospitals which were matched to 16 public hospitals of similar sizes and driving distance.

Results of the study found that hospitals in the sample may respond differently to diversions of neighboring public vs. private hospitals. “Diversions act as a release valve – once an emergency department has declared a diversion, others in the area are likely to follow,” said Hsuan. Adding, “when hospitals declare an ambulance diversion, a vulnerable population may be extraordinarily disadvantaged.” Previous research suggests that minorities and low-income are particularly affected by such diversions. Those who live in areas where there is a restricted access to care are more likely to be affected, but may not realize it because in most cases, patients may not even know they are being diverted to a hospital that is further away. Hsuan shared that there is a need for more research on the issue to help local, state and federal authorities learn and work toward improving factors influencing such diversions.

The findings recently appeared in the journal, Health Services Research (HSR).

Authors of the paper include Charleen Hsuan, assistant professor, health policy and administration, Penn State; Renee Hsia, MD, professor, UCSF; Jill Horwitz, professor, School of Law, UCLA; Ninez Ponce, professor, health policy and management, UCLA; Thomas Rice, professor, health policy and management, UCLA; and Jack Needleman, professor, health policy and management, UCLA.