The doctor will be with you ... shortly?: The effect of insurance coverage on ED wait time

Abstract

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. © 2014 Springer Science+Business Media New York.