Sue Ducat
Director of Communications
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Melissa Blair
Robert Wood Johnson Foundation
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Ambulance Diversion

A new policy brief from Health Affairs and the Robert Wood Johnson Foundation discusses efforts to address ambulance diversion, a controversial strategy for temporarily relieving overcrowding in emergency departments (EDs). According to 2015 data, the national median time for a patient, from arrival to placement in an inpatient bed, was 279 minutes. Ambulance diversion was initially viewed as a safety valve. However, the approach has yielded unintended long-term negative consequences and raises questions of equity, since it disproportionately impacts minority populations. Since many factors can impact ED overcrowding, experts generally consider restricting ambulance diversion, on its own, to be an ineffective and shortsighted strategy for addressing the problem.

Topics covered by this policy brief include:

  • What’s the background? This section of the brief reports concern in the policy community about the growing use of EDs (from 359 ED visits per 1,000 people in 1993 to 423 per 1,000 people in 2013), coupled with a declining number of EDs serving nonurban populations. As the brief suggests, risk factors for closure included low profit margins, safety-net status, and a high proportion of patients living in poverty.

  • What’s the debate? According to the brief, efforts to control diversion have demonstrated some positive impacts. It describes studies over the past decade, in different parts of the country, that examined the effects of banning or limiting ambulance diversion—and notes that while the Affordable Care Act (ACA) did not include provisions about ambulance diversion, the needs of the many millions of newly insured people have contributed to a continued increase in ED demand.

  • What’s next? Since ambulance diversion has proved to be a complex issue to address, the brief notes that recent approaches incorporating multiple strategies are more likely to generate long-term changes. Also, says the brief, hospitals have come to recognize that they have significant financial incentive to grapple with ambulance diversion, since sending patients away results in revenue losses.

About Health Policy Briefs

Health Policy Briefs are aimed at policy makers, congressional staffers, and others needing short, jargon-free explanations of health policy basics. The briefs, which are reviewed by experts in the field, include competing arguments on policy proposals and the relevant research supporting each perspective.

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About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with additional Web First papers and health policy briefs published regularly at Read daily perspectives on Health Affairs Blog and customize the content you want to see in Health Affairs Alerts.

About the Robert Wood Johnson Foundation

For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit Follow the Foundation on Twitter at or on Facebook at