title: Does the emergency medical treatment and labor act affect emergency department use?
abstract: BACKGROUND
  Emergency departments (EDs) face increasing patient volumes and economic pressures. These problems have been attributed to the Emergency Medical Treatment and Labor Act (EMTALA).
  
  
  OBJECTIVE
  To determine whether modifying EMTALA might reduce ED use.
  
  
  METHODS
  We surveyed ED patients to assess their knowledge of hospitals' obligations to treat all patients regardless of insurance and to determine whether knowledge is associated with ED use.
  
  
  RESULTS
  Among 4136 study subjects, 72% reported awareness of the law. Sixty-one percent of subjects were moderate ED users (≥ 1 additional ED visit in 12 months). Moderate users more often knew the law (74% vs. 70%, p=0.005). Multivariate regression showed that factors associated with moderate use were: awareness of EMTALA (odds ratio [OR] 1.44; 95% confidence interval [CI] 1.24-1.67), adult patient (OR 1.94; 95% CI 1.69-2.22), and government insurance (OR 2.67; 95% CI 2.30-3.08) or uninsured (OR 1.72; 95% CI 1.42-2.08). Only 8% of subjects were high-frequency users (≥5 visits). High-frequency users were more often aware of EMTALA (78% vs. 72%, p=0.02). Covariates associated with high frequency were EMTALA awareness (OR 1.69; 95% CI 1.28-2.24), adult patient (OR 2.59; 95% CI 2.00-3.36), and government insurance (OR 3.73; 95% CI 2.76-5.06) or uninsured (OR 3.77; 95% CI 2.65-5.35).
  
  
  CONCLUSIONS
  Many patients know that the law requires hospitals to provide care. This knowledge is associated with more frequent ED use. EMTALA changes might reduce ED use, but broader policy implications should be considered.
authors.affiliation: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah 84158, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: McDonnell
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Gee
authors.forename: Nancy
authors.initials: N
authors.lastname: Mecham
authors.forename: Jessica
authors.initials: J
authors.lastname: Dahl-Olsen
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Guenther
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence; D008875:Middle Aged; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult