Ambulance diversions following public hospital emergency department closures

Charleen Hsuan, Renee Y. Hsia, Jill R. Horwitz, Ninez A. Ponce, Thomas Rice, Jack Needleman

Research output: Contribution to journalArticle

Abstract

Objective: To examine whether hospitals are more likely to temporarily close their emergency departments (EDs) to ambulances (through ambulance diversions) if neighboring diverting hospitals are public vs private. Data Sources/Study Setting: Ambulance diversion logs for California hospitals, discharge data, and hospital characteristics data from California's Office of Statewide Health Planning and Development and the American Hospital Association (2007). Study Design: We match public and private (nonprofit or for-profit) hospitals by distance and size. We use random-effects models examining diversion probability and timing of private hospitals following diversions by neighboring public vs matched private hospitals. Data Collection/Extraction Methods: N/A. Principal Findings: Hospitals are 3.6 percent more likely to declare diversions if neighboring diverting hospitals are public vs private (P < 0.001). Hospitals declaring diversions have lower ED occupancy (P < 0.001) after neighboring public (vs private) hospitals divert. Hospitals have 4.2 percent shorter diversions if neighboring diverting hospitals are public vs private (P < 0.001). When the neighboring hospital ends its diversion first, hospitals terminate diversions 4.2 percent sooner if the neighboring hospital is public vs private (P = 0.022). Conclusions: Sample hospitals respond differently to diversions by neighboring public (vs private) hospitals, suggesting that these hospitals might be strategically declaring ambulance diversions to avoid treating low-paying patients served by public hospitals.

Original languageEnglish (US)
Pages (from-to)870-879
Number of pages10
JournalHealth Services Research
Volume54
Issue number4
DOIs
StatePublished - Aug 2019

All Science Journal Classification (ASJC) codes

  • Health Policy

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    Hsuan, C., Hsia, R. Y., Horwitz, J. R., Ponce, N. A., Rice, T., & Needleman, J. (2019). Ambulance diversions following public hospital emergency department closures. Health Services Research, 54(4), 870-879. https://doi.org/10.1111/1475-6773.13147