Insurance-based inequities in emergency interhospital transfers: an argument for the prioritisation of patient care
Abstract
Currently there is an inequity in transfer rates of uninsured patients versus their insured counterparts. While this may vary by hospital system, studies indicate that this is a national trend, especially in emergency situations, and represents a prioritisation of profits over ethical obligations. This creates a variety of ethical issues for patients and society that generates a concordance between deontological and utilitarian viewpoints, two generally opposed schools of thought. The prioritisation of profit maximisation in order to provide better care for a select population is insufficient to justify deleterious health outcomes, stress and financial burden on patients. Current policy regarding patient transfers in the emergency department is insufficient to protect the uninsured and must be reevaluated.
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Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions
Hoot, N. R., & Aronsky, D. (2008) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2008.03.014 · Cited by 1,689 · see citing works
The Strategy That Will Fix Health Care
Porter, M. E., & Lee, T. H.-Y. (2013) · Cited by 867 · see citing works
Intrahospital transport of critically ill patients.
Waydhas, C. (1999) · Critical Care · doi:10.1186/cc362 · Cited by 300 · see citing works
Eriksson, C. O., Stoner, R. C., Eden, K., Newgard, C. D., & Guise, J. (2016) · Journal of General Internal Medicine · doi:10.1007/s11606-016-3936-3 · Cited by 209 · see citing works
Inter-hospital and intra-hospital patient transfer: Recent concepts
Kulshrestha, A., & Singh, J. (2016) · Indian Journal of Anaesthesia · doi:10.4103/0019-5049.186012 · Cited by 164 · see citing works
Zibulewsky, J. (2001) · Baylor University Medical Center Proceedings · doi:10.1080/08998280.2001.11927785 · Cited by 130 · see citing works
Delgado, M. K., Yokell, M. A., Staudenmayer, K., Spain, D. A., Hernandez‐Boussard, T., & Wang, N. E. (2014) · JAMA Surgery · doi:10.1001/jamasurg.2013.4398 · Cited by 108 · see citing works
Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition
Venkatesh, A. K., Chou, S., Li, S., Choi, J. E. S., Ross, J. S., D’Onofrio, G., Krumholz, H. M., & Dharmarajan, K. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.0037 · Cited by 76 · see citing works
Thakur, N. A., Plante, M. J., Kayiaros, S. T., et al. (2010) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0b013e3181b18b89 · Cited by 73 · see citing works
Kindermann, D. R., Mutter, R. L., Cartwright-Smith, L., Rosenbaum, S., & Pines, J. M. (2013) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.11.019 · Cited by 66 · see citing works
Esposito, T. J., Crandall, M. L., Reed, R. L., et al. (2006) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/01.ta.0000242862.68899.04 · Cited by 50 · see citing works
Appropriateness of Patient Transfer With Associated Orthopaedic Injuries to a Level I Trauma Center
Crichlow, R. J., Zeni, A., Reveal, G., et al. (2010) · Journal of Orthopaedic Trauma · doi:10.1097/bot.0b013e3181ddfde9 · Cited by 44 · see citing works
Insurance Status and the Transfer of Hospitalized Patients
Hanmer, J., Lu, X., Rosenthal, G. E., et al. (2014) · Annals of Internal Medicine · doi:10.7326/m12-1977 · Cited by 30 · see citing works
Can Medical Repatriation Be Ethical? Establishing Best Practices
Kuczewski, M. G. (2012) · The American Journal of Bioethics · doi:10.1080/15265161.2012.692433 · Cited by 30 · see citing works
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): Challenges and solutions
Hsuan, C., Horwitz, J. R., Ponce, N. A., et al. (2017) · Journal of Healthcare Risk Management · doi:10.1002/jhrm.21288 · Cited by 27 · see citing works
Insurance Status Biases Trauma-system Utilization and Appropriate Interfacility Transfer
Zogg, C. K., Schuster, K. M., Maung, A. A., & Davis, K. A. (2018) · Annals of Surgery · doi:10.1097/sla.0000000000002954 · Cited by 23 · see citing works
Association Between Insurance and Transfer of Injured Children From Emergency Departments
Huang, Y., Kissee, J. L., Dayal, P., et al. (2017) · PEDIATRICS · doi:10.1542/peds.2016-3640 · Cited by 18 · see citing works
Usher, M. G., Fanning, C., Fang, V. W., et al. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4687-0 · Cited by 14 · see citing works
PEDIATRIC TRAUMA CARE IS COST EFFECTIVE
Levy, E. N., Griffith, J. A., & Carvajal, H. F. (1994) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/00005373-199404000-00008 · Cited by 13 · see citing works
Financial Impact of Minor Injury Transfers on a Level 1 Trauma Center
Kappy, N. S., Hazelton, J. P., Capano-Wehrle, L. M., et al. (2018) · Journal of Surgical Research · doi:10.1016/j.jss.2018.08.036 · Cited by 6 · see citing works
Pediatric trauma care: a profitable enterprise?
Gutweiler, J. R., & Mooney, D. P. (2007) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2007.01.040 · Cited by 4 · see citing works
The Ethics of Institutional Transfers: Emergency Hand Transfers in the Context of EMTALA
Gowani, Z. S., & Lee, D. H. (2016) · The Journal Of Hand Surgery · doi:10.1016/j.jhsa.2015.12.016 · Cited by 2 · see citing works
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Iantorno, S. E., Bucher, B. T., Horns, J. J., & McCrum, M. L. (2023) · Journal of Trauma and Acute Care Surgery · doi:10.1097/ta.0000000000003856 · Cited by 11 · see citing works
- Authors
- Riegler, J.
- Affiliations
- University of Central Florida (US)
- Corresponding author
- Riegler, Jacob
- ORCID
- Riegler, Jacob
- Venue
- Journal of Medical Ethics
- Publisher
- BMJ
- Published
- 2021-01-28
- Volume
- 47
- Issue
- 11
- Pages
- 766-769
- ISSN
- 0306-6800 (ISSN-L)
- 1473-4257
- OpenAlex
- W3121843446
- Cited by
- 1
- References
- 22
- Citations by year
- 2022: 1
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Medical Ethics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- uninsured patients, health insurance, health disparities, emergency department, deontology, utilitarianism, profit maximization, patient prioritization, patient financial burden, health policy
- MeSH terms
- Emergencies, Emergency Service, Hospital, Humans, Insurance, Health, Patient Transfer, Medically Uninsured
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