Working Paper: NBER ID: w24480
Authors: Charles Courtemanche; Andrew Friedson; Daniel I. Rees
Abstract: Expanding insurance coverage could, by insulating patients from having to pay full cost, encourage the utilization of arguably unnecessary medical services. It could also eliminate (or at least diminish) the need for emergency services through increasing access to preventive care. Using publicly available data from New York City for the period 2013-2016, we explore the effect of the Affordable Care Act (ACA) on the volume and composition of ambulance dispatches. Consistent with the argument that expanding insurance coverage encourages the utilization of unnecessary medical services, we find that, as compared to dispatches for more severe injuries, dispatches for minor injuries rose sharply after the implementation of the ACA. By contrast, dispatches for pre-labor pregnancy complications decreased as compared to dispatches for women in labor.
Keywords: Ambulance utilization; Affordable Care Act; Emergency services
JEL Codes: I11; I13; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| ACA (G52) | dispatches for minor injuries (I19) |
| ACA (G52) | dispatches for severe injuries (J28) |
| improved access to preventive care (I14) | dispatches for pre-labor pregnancy complications (J22) |
| dispatches for pre-labor pregnancy complications (J22) | dispatches for women in active labor (J22) |