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Patient 'dumping' post-COBRA.

A L Kellermann1, B B Hackman

  • 1Department of Medicine, University of Tennessee, Memphis 38103.

American Journal of Public Health
|July 1, 1990
PubMed
Summary
This summary is machine-generated.

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The federal patient transfer law (COBRA) had minimal impact on emergency interhospital transfers in Memphis. Hospital overcrowding significantly reduced transfers in 1988, overshadowing COBRA's effects.

Area of Science:

  • Health Services Research
  • Public Health Policy
  • Emergency Medicine

Background:

  • The federal Combined Budget Reconciliation Act of 1985 (COBRA) introduced new patient transfer provisions.
  • Understanding the real-world impact of such legislation on healthcare systems is crucial.

Purpose of the Study:

  • To evaluate the effect of COBRA's patient transfer provisions on emergency interhospital transfers.
  • To assess the influence of federal policy versus hospital-level factors on transfer volumes.

Main Methods:

  • Monitoring emergency interhospital transfers to a Memphis public hospital ED over three summers (1986, 1987, 1988).
  • Comparing transfer data before and after COBRA implementation.
  • Analyzing the role of hospital overcrowding in transfer refusal.
Keywords:
Consolidated Omnibus Budget Reconciliation Act (COBRA)Empirical ApproachHealth Care and Public HealthLegal ApproachMemphis

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Main Results:

  • A slight decrease in transfers was observed in summer 1987, following COBRA's implementation.
  • A significant reduction in transfers occurred in summer 1988 due to hospital overcrowding and transfer refusals.
  • COBRA alone demonstrated a limited effect on transfer volumes in this specific region.

Conclusions:

  • Hospital overcrowding and internal policies played a more substantial role in reducing patient transfers than COBRA.
  • Federal patient transfer legislation may have limited impact without addressing underlying system pressures like overcrowding.