In recent years there has been a dramatic increase in the number of patients transferred to public hospitals in the United States. We prospectively studied 467 medical and surgical patients who were transferred from the emergency departments of other hospitals in the Chicago area to Cook County Hospital and subsequently admitted. Eighty-nine percent of the transferred patients were black or Hispanic, and 81 percent were unemployed. Most (87 percent) were transferred because they lacked adequate medical insurance. Only 6 percent of the patients had given written informed consent for transfer. Twenty-two percent required admission to an intensive care unit, usually within 24 hours of arrival. Twenty-four percent were in an unstable clinical condition at the transferring hospital. The proportion of transferred medical-service patients who died was 9.4 percent, which was significantly higher than the proportion of medical-service patients who were not transferred (3.8 percent, P<0.01). There was no significant difference in the proportion of deaths on the surgical service between patients who were transferred and those who were not (1.5 vs. 2.4 percent). We conclude that patients are transferred to public hospitals predominantly for economic reasons, in spite of the fact that many of them are in an unstable condition at the time of transfer. (N Engl J Med 1986; 314:552–7.), THE transfer of patients from one hospital to another is a widespread practice throughout the United States. Transfer is considered appropriate when there is a need for specialty or tertiary care that is unavailable at the transferring hospital.1,2 Inability to pay for hospital services is also regarded by some as an acceptable reason for the transfer of patients from private to public hospitals. This has been a long-standing practice in such cities as Chicago, Oakland, Los Angeles, Dallas, Atlanta, and Washington, D.C.3 4 5 6 7 8 9 In recent years there have been increases in the number of interhospital transfers of patients to public general.
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