Patient 'dumping' post-COBRA.

To gauge the impact of the new federal patient transfer provisions following the federal Combined Budget Reconciliation Act of 1985 (COBRA), we monitored all emergency interhospital transfers to a public hospital emergency department in the Memphis, Tennessee area during three identical time periods: June 1 to August 31 of 1986, 1987, and 1988. A high number of transfers in the summer of 1986 diminished only slightly in summer 1987 (following implementation of COBRA). Far greater reductions occurred in summer 1988, when overcrowding forced our hospital to refuse most transfers. In contrast to changes in hospital policy, COBRA alone had little effect in this area.