Association of Affordable Care Act Implementation with Ambulance Utilization for Asthma Emergencies in New York City, 2008-2018

Abstract

Importance: Emergency medical services (EMS) are an essential component of the health care system, but the effect of insurance expansion on EMS call volume remains unclear. Objective: This study investigated the association between health insurance expansion and EMS dispatches for asthma, an ambulatory care-sensitive condition. We hypothesized that insurance expansion under the Patient Protection and Affordable Care Act (ACA) would be associated with decreased EMS dispatches for asthma emergencies. Design, Setting, and Participants: This cohort study examined 14865267 ambulance calls dispatched within New York City from 2008 to 2018, including 217303 calls for asthma-related emergencies, and used interrupted time series analysis to study the change in the annual incidence of EMS dispatches for asthma emergencies after implementation of the ACA. Multivariable linear regression examined the association between the uninsured rate and the incidence of asthma-related dispatches, controlling for population demographic characteristics and air quality index. Exposures: Implementation of ACA on January 1, 2014. Main Outcomes and Measures: Incidence of EMS dispatches for asthma emergencies per 100000 population per year (ie, asthma EMS dispatch rate) as classified by the 911 call-taker. Results: In this study of 217303 EMS dispatches for asthma-related emergencies, there was a decrease in the asthma EMS dispatch rate after implementation of the ACA, from a mean (SD) of 261 (24) dispatches per 100000 population per year preintervention to 211 (47) postintervention (P =.047). This decrease in asthma EMS dispatch rate after ACA implementation was significant on interrupted time series analysis. Prior to 2014, the annual asthma EMS dispatch rate was increasing by 11.8 calls per 100000 population per year (95% CI, 6.1 to 17.4). After ACA implementation, the asthma EMS dispatch rate decreased annually by 28.5 calls per 100000 population per year (95% CI, -37.6 to -19.3), a significant change in slope from the preintervention period (P