Uninsured patients are more likely to be transferred between hospitals, UMN study says

A University of Minnesota study found uninsured patients are more likely to be transferred between hospitals, which could lead to higher mortality rates.

by Michelle Griffith

Uninsured patients face less stability in emergency rooms, which could lead to higher mortality rates, according to a November study from a University of Minnesota faculty member.

The study looked at approximately 353,000 transfers in five states and found that uninsured patients are more likely to be transferred from one hospital to another, which may have negative impacts on their health.

Some hospitals are motivated to transfer uninsured patients because they don’t want to pay the bill, said Michael Usher, a University associate professor and physician who authored the study.

According to the Emergency Medical Treatment and Labor Act, a federal law passed in 1986, hospitals are required to treat patients in their emergency room regardless of their ability to pay or insurance status. If the hospital does not have the resources to treat the patient, they must transfer them to another hospital. 

“The problem with EMTALA is while it mandated hospitals to take care of these emergencies, it didn’t provide any way to systematize these patients’ care and it doesn’t create any way to pay for it,” Usher said.

The study did not analyze whether hospital transfers were the cause for the higher mortality, but did find that the transfers could contribute to their higher mortality rate, according to Usher. 

According to the Minnesota Department of Health, around 349,000 Minnesotans were uninsured in 2017 — a number that is growing. Young adults, people with a high school education or less and people of color had the highest uninsured rates in the state.

Transferring patients from one hospital to another is a flawed system, Usher said. The transition of information is limited, and often only includes a printed copy of the patient’s records and a five-minute phone call between hospitals, he added. Death may be an unfortunate consequence of this system. 

This process can often lead to miscommunication between the hospitals or the exclusion of important medical facts, he said. 

Uninsured people have lower life expectancies overall, said Mark Brakke, a retired physician and board member of Health Care for All Minnesota, a health care advocacy organization.

“Often when [an uninsured patient] is feeling sick, they avoid getting care and may even become seriously ill,” Brakke said. 

With the number of uninsured people in Minnesota rising, MNsure, a company created due to the Affordable Care Act, helps uninsured Minnesotans enroll for insurance through various outreach programs, said MNsure spokesperson Marie Harmon in a statement to the Minnesota Daily. 

Looking forward, Usher is using the study to see the effect of the ACA on the uninsured population and their hospital transfers. 

Usher said it’s ultimately the general population who pays for uninsured patients, so there needs to be a system for treating the patients who cannot pay. 

“All in all, having uninsured patients doesn’t make any sense,” Usher said.