INTERHOSPITAL TRANSFERS, THE COBRA LAW (1985), AND THE USE OF A PUBLIC-ASSISTANCE HEALTH PLAN

Public outcry regarding unsafe interhospital patient transfers led to the passage of the COBRA Law of 1985. Since its implementation 1986, t he law has been sharply criticized for its sporadic enforcement, narro w focus, and lack of care provisions for the poor. We reviewed retrosp ectively the charts of all emergency department patients transferred f rom two Milwaukee private hospitals during two identical 6-month perio ds in 1985-1986 and 1988-1989. We compared demographic and clinical ch aracteristics for the patients transferred during the two periods. The emergency departments cared for 15% of Milwaukee's emergency patient population and transferred 216 and 200 patients during each respective period. Uninsured transfers fell from 32% to 17% of the study populat ions. Although the proportion of the local population belonging to a h ealth maintenance organization (HMO) did not change, transfer of HMO p atients increased from 14% to 27%. Transfers to the area's various ter tiary care centers made up 21% and 35% of all transfers and were condu cted without regard to insurance status. There was a fourfold increase in the use of the country's public assistance plan for emergency hosp italization of indigent patients at local hospitals. Although the numb er of uninsured patients transferred from the study hospitals decrease d markedly, this decrease was counterbalanced by increased private hos pital use of the country's emergency hospitalization plan for indigent patients. This successful plan bears further examination by health po licy planners as an important model for the provision of emergency hos pitalization for the indigent.