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The Affordable Care Act and Ambulance Response Times

Author

Listed:
  • Courtemanche, Charles

    (University of Kentucky)

  • Friedson, Andrew I.

    (University of Colorado Denver)

  • Koller, Andrew P.

    (University of Colorado Denver)

  • Rees, Daniel I.

    (Universidad Carlos III de Madrid)

Abstract

This study contributes to the literature on supply-side adjustments to insurance expansions by examining the effect of the Affordable Care Act (ACA) on ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 19%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA added strain to emergency response systems.

Suggested Citation

  • Courtemanche, Charles & Friedson, Andrew I. & Koller, Andrew P. & Rees, Daniel I., 2017. "The Affordable Care Act and Ambulance Response Times," IZA Discussion Papers 10951, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp10951
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    1. Thomas C. Buchmueller & Sarah Miller & Marko Vujicic, 2014. "How Do Providers Respond to Public Health Insurance Expansions? Evidence from Adult Medicaid Dental Benefits," NBER Working Papers 20053, National Bureau of Economic Research, Inc.
    2. Thomas E. Lambert & Peter B. Meyer, 2006. "Ex-Urban Sprawl as a Factor in Traffic Fatalities and EMS Response Times in the Southeastern United States," Journal of Economic Issues, Taylor & Francis Journals, vol. 40(4), pages 941-953, December.
    3. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    4. Bhashkar Mazumder & Sarah Miller, 2016. "The Effects of the Massachusetts Health Reform on Household Financial Distress," American Economic Journal: Economic Policy, American Economic Association, vol. 8(3), pages 284-313, August.
    5. Barbaresco, Silvia & Courtemanche, Charles J. & Qi, Yanling, 2015. "Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults," Journal of Health Economics, Elsevier, vol. 40(C), pages 54-68.
    6. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    7. Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
    8. Charles J. Courtemanche & Daniela Zapata, 2014. "Does Universal Coverage Improve Health? The Massachusetts Experience," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 33(1), pages 36-69, January.
    9. Unknown, 2014. "Media Coverage 2014," 2014: Ethics, Efficiency and Food Security: Feeding the 9 Billion, Well, 26-28 August 2014 225573, Crawford Fund.
    10. Bhashkar Mazumder & Sarah Miller, 2014. "The Effects of the Massachusetts Health Reform on Financial Distress," Working Paper Series WP-2014-1, Federal Reserve Bank of Chicago.
    11. Peters, Jeremy & Hall, G. Brent, 1999. "Assessment of ambulance response performance using a geographic information system," Social Science & Medicine, Elsevier, vol. 49(11), pages 1551-1566, December.
    12. Joseph J. Doyle Jr. & John A. Graves & Jonathan Gruber & Samuel A. Kleiner, 2015. "Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns," Journal of Political Economy, University of Chicago Press, vol. 123(1), pages 170-214.
    13. Guy David & Tanguy Brachet, 2011. "On the Determinants of Organizational Forgetting," American Economic Journal: Microeconomics, American Economic Association, vol. 3(3), pages 100-123, August.
    14. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    15. Dafny, Leemore & Gruber, Jonathan, 2005. "Public insurance and child hospitalizations: access and efficiency effects," Journal of Public Economics, Elsevier, vol. 89(1), pages 109-129, January.
    16. Kosali Simon & Aparna Soni & John Cawley, 2017. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(2), pages 390-417, March.
    17. Arnott, Richard & de Palma, Andre & Lindsey, Robin, 1993. "A Structural Model of Peak-Period Congestion: A Traffic Bottleneck with Elastic Demand," American Economic Review, American Economic Association, vol. 83(1), pages 161-179, March.
    18. Ellis, Randall P. & Martins, Bruno & Zhu, Wenjia, 2017. "Health care demand elasticities by type of service," Journal of Health Economics, Elsevier, vol. 55(C), pages 232-243.
    19. David, Guy & Harrington, Scott E., 2010. "Population density and racial differences in the performance of emergency medical services," Journal of Health Economics, Elsevier, vol. 29(4), pages 603-615, July.
    20. Charles Courtemanche & Andrew Friedson & Daniel I. Rees, 2018. "Ambulance Utilization in New York City after the Implementation of the Affordable Care Act," NBER Working Papers 24480, National Bureau of Economic Research, Inc.
    21. Elizabeth Ty Wilde, 2013. "Do Emergency Medical System Response Times Matter For Health Outcomes?," Health Economics, John Wiley & Sons, Ltd., vol. 22(7), pages 790-806, July.
    22. Robert Kaestner & Bowen Garrett & Jiajia Chen & Anuj Gangopadhyaya & Caitlyn Fleming, 2017. "Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(3), pages 608-642, June.
    23. Shah, M.N., 2006. "The formation of the emergency medical services system," American Journal of Public Health, American Public Health Association, vol. 96(3), pages 414-423.
    24. Lichtenberg Frank R., 2002. "The Effects of Medicare on Health Care Utilization and Outcomes," Forum for Health Economics & Policy, De Gruyter, vol. 5(1), pages 1-29, January.
    25. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2017. "Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(1), pages 178-210, January.
    26. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2016. "Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States," NBER Working Papers 22182, National Bureau of Economic Research, Inc.
    27. Frean, Molly & Gruber, Jonathan & Sommers, Benjamin D., 2017. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act," Journal of Health Economics, Elsevier, vol. 53(C), pages 72-86.
    28. Susan Athey & Scott Stern, 2002. "The Impact of Information Technology on Emergency Health Care Outcomes," RAND Journal of Economics, The RAND Corporation, vol. 33(3), pages 399-432, Autumn.
    29. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    30. Jonathan Gruber, 2011. "The Impacts of the Affordable Care Act: How Reasonable Are the Projections?," NBER Working Papers 17168, National Bureau of Economic Research, Inc.
    31. Charles Courtemanche & James Marton & Aaron Yelowitz, 2016. "Who Gained Insurance Coverage in 2014, the First Year of Full ACA Implementation?," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 778-784, June.
    32. Leon Moskatel & David Slusky, 2019. "Did UberX reduce ambulance volume?," Health Economics, John Wiley & Sons, Ltd., vol. 28(7), pages 817-829, July.
    33. Craig L. Garthwaite, 2012. "The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions," American Economic Journal: Economic Policy, American Economic Association, vol. 4(3), pages 190-215, August.
    34. Gruber, Jonathan, 2011. "The Impacts of the Affordable Care Act: How Reasonable Are the Projections?," National Tax Journal, National Tax Association;National Tax Journal, vol. 64(3), pages 893-908, September.
    35. Sarah Miller, 2012. "The Impact of the Massachusetts Health Care Reform on Health Care Use among Children," American Economic Review, American Economic Association, vol. 102(3), pages 502-507, May.
    36. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    37. Miller, Sarah, 2012. "The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform," Journal of Public Economics, Elsevier, vol. 96(11), pages 893-908.
    38. Kosali Simon & Aparna Soni & John Cawley, 2016. "The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the 2014 ACA Medicaid Expansions," NBER Working Papers 22265, National Bureau of Economic Research, Inc.
    39. Akosa Antwi, Yaa & Moriya, Asako S. & Simon, Kosali I., 2015. "Access to health insurance and the use of inpatient medical care: Evidence from the Affordable Care Act young adult mandate," Journal of Health Economics, Elsevier, vol. 39(C), pages 171-187.
    40. Kondo, Ayako & Shigeoka, Hitoshi, 2013. "Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan," Journal of Public Economics, Elsevier, vol. 99(C), pages 1-23.
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    Cited by:

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    2. Chaudhary, Sookti & Davis, Alison & Troske, Kenneth & Troske, SuZanne, 2019. "Hospital Closures and Short-Run Change in Ambulance Call Times," IZA Discussion Papers 12797, Institute of Labor Economics (IZA).
    3. Nicole Black & Anthony Harris & David W. Johnston & Trong-Anh Trinh, 2024. "Workforce Impacts of Subsidised Mental Healthcare: Evidence on Supply, Earnings, and Geographic Distribution," Papers 2024-17, Centre for Health Economics, Monash University.
    4. Michael DiNardi, 2021. "Affordable Care Act Medicaid expansions and the nurse labor market," Southern Economic Journal, John Wiley & Sons, vol. 88(1), pages 367-398, July.
    5. Louis‐Philippe Beland & Jason Huh & Dongwoo Kim, 2021. "The effect of Affordable Care Act Medicaid expansions on foster care admissions," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2943-2951, November.
    6. Leon Moskatel & David Slusky, 2019. "Did UberX reduce ambulance volume?," Health Economics, John Wiley & Sons, Ltd., vol. 28(7), pages 817-829, July.
    7. Dunn, Abe & Knepper, Matthew & Dauda, Seidu, 2021. "Insurance expansions and hospital utilization: Relabeling and reabling?," Journal of Health Economics, Elsevier, vol. 78(C).
    8. Jingshu Luo & Hua Chen & Martin Grace, 2022. "Medicaid expansion, tort reforms, and medical liability costs," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 89(3), pages 789-821, September.
    9. Argys, Laura M. & Friedson, Andrew I. & Pitts, M. Melinda & Tello-Trillo, D. Sebastian, 2020. "Losing public health insurance: TennCare reform and personal financial distress," Journal of Public Economics, Elsevier, vol. 187(C).
    10. Elena Lucchese, 2020. "It could be worse...it could be raining: Ambulance response time and health outcomes," Working Papers 429, University of Milano-Bicocca, Department of Economics, revised Feb 2020.
    11. Christal Hamilton, 2024. "The impact of the 2014 Medicaid expansion on the health, health care access, and financial well‐being of low‐income young adults," Health Economics, John Wiley & Sons, Ltd., vol. 33(8), pages 1895-1925, August.
    12. Charles Courtemanche & Andrew Friedson & Daniel I. Rees, 2018. "Ambulance Utilization in New York City after the Implementation of the Affordable Care Act," NBER Working Papers 24480, National Bureau of Economic Research, Inc.
    13. Dillender, Marcus & Friedson, Andrew & Gian, Cong & Simon, Kosali, 2019. "Does the healthcare educational market respond to short-run local demand?," Economics of Education Review, Elsevier, vol. 73(C).
    14. Elena Lucchese, 2024. "How important are delays in treatment for health outcomes? The case of ambulance response time and cardiovascular events," Health Economics, John Wiley & Sons, Ltd., vol. 33(4), pages 652-673, April.
    15. Hector Galindo-Silva & Nibene Habib Some & Guy Tchuente, 2018. "Fuzzy Difference-in-Discontinuities: Identification Theory and Application to the Affordable Care Act," Papers 1812.06537, arXiv.org, revised Apr 2021.
    16. Louis-Philippe Beland & Jason Huh & Dongwoo Kim, 2021. "The Effect of ACA Medicaid Expansions on Foster Care Admissions," Carleton Economic Papers 21-07, Carleton University, Department of Economics.
    17. Yelowitz, Aaron & Ingram, Samuel J., 2021. "How Does Occupational Licensing Affect Entry into the Medical Field? An Examination of EMTs," IZA Discussion Papers 14071, Institute of Labor Economics (IZA).
    18. Bjoerkheim, Markus & Sigaud, Liam & Ampaabeng, Kofi, 2023. "The Effect of the Affordable Care Act's Medicaid Expansion on the Mental Health Of Already-Enrolled Medicaid Beneficiaries," Working Papers 12430, George Mason University, Mercatus Center.
    19. Laura Argys & Andrew Friedson & M. Melinda Pitts & D. Sebastian Tello-Trillo, 2017. "Losing Public Health Insurance: TennCare Disenrollment and Personal Financial Distress," FRB Atlanta Working Paper 2017-6, Federal Reserve Bank of Atlanta.

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    More about this item

    Keywords

    health care capacity; health insurance; ambulance; Affordable Care Act; health care workforce;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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