Does an Overcrowded Emergency Department Reduce Moral Hazard? Lessons from Emergency Department Visits to Three...

Area of Science:

• Health Services Research
• Hospital Management
• Public Health Policy

Background:

• Metropolitan Haifa has three major hospitals: Rambam Health Care Campus (RHCC), Bnai Zion Medical Center, and Carmel Medical Center.
• RHCC experienced increased emergency department (ED) length of stay (LOS) and decreased patient visits between 2007-2014.
• This trend raises questions about inter-hospital competition and referral patterns.

Purpose of the Study:

• To investigate the association between increased ED LOS at one hospital and changes in visit numbers at competing hospitals.
• To determine if longer LOS at a hospital influences referrals to other metropolitan EDs.
• To examine the impact of ED crowding on mitigating moral hazard in healthcare.

Main Methods:

• Comparative analysis of ED visit data and length of stay (LOS) across three hospitals in Metropolitan Haifa from 2000-2018.
• Statistical analysis, including one-way ANOVA, to identify significant differences in LOS among hospitals.
• Examination of referral trends in relation to fluctuating LOS and visit volumes.

Main Results:

• Average LOS at Rambam Health Care Campus increased from 3.5 hours (2000-2007) to 6.4 hours (2008-2018).
• While Rambam's visits decreased, Bnai Zion Medical Center saw a significant, linear increase in visits.
• A significant difference in LOS was found among the three hospitals, with Rambam differing significantly from Carmel but not Bnai Zion.

Conclusions:

• Increased ED LOS at one hospital is associated with shifts in patient visits to competing facilities.
• Changes in LOS appear to influence inter-hospital referral dynamics.
• Policy recommendations include public LOS data, referral regulation, and optimizing LOS to reduce competition and moral hazard.