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Variations in Ambulance Use in the United States: the Role of Health Insurance
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    The purpose of this study was to describe the associations between individual health insurance and ambulance utilization using a national sample of patients who receive emergency department (ED) care.


    The data source was the National Hospital Ambulatory Medical Care Survey, years 2004 through 2006. Non-institutionalized patients between ages 18 and 65 years were included. The primary dependant variable was ambulance use. Multivariable logistic regression methods were used to assess the associations between health insurance status and ambulance use, and to adjust for confounders.


    A total of 61,013 ED visits were included, representing a national sample of approximately 70 million annual ED visits over three years. Ambulance transport was used in 11% of private insurance visits, 16% of Medicaid visits, and 13% of uninsured visits. In the adjusted model, visits by patients with Medicaid (aOR 1.60, 99% confidence interval (CI) = 1.37 to 1.86) and the uninsured (aOR 1.43, 99% CI = 1.23 to 1.66) were more likely to arrive by ambulance than visits by patients with private insurance. Ambulance use among the uninsured was most pronounced in metropolitan areas.


    Ambulance use varies by health insurance status. Medicaid coverage and lack of insurance are each independently associated with increased odds of ambulance use, suggesting a disproportionate role for EMS in the care of patients with limited financial resources.

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    K24A1073967/PHS HHS/United States
    KM1 CA156715/CA/NCI NIH HHS/United States
    KM1 CA156715-01/CA/NCI NIH HHS/United States
    R01CE001615/CE/NCIPC CDC HHS/United States
    R01HS018362/HS/AHRQ HHS/United States
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