for the period between 2005 and 2014, and that the majority of the citations were given to hospitals for issues with policy enforcement. However, there is not a consensus among researchers about how to effectively measure the effects of EMTALA at reducing patient dumping or improving patient care. Associated factors Patients living in poverty or in homelessness are often seen as less than ideal patients for hospital administrations because they are unlikely to be able to pay for their healthcare and tend to be hospitalized with severe illness. Other factors associated with patient dumping are being part of a minority group and being uninsured. Historically, hospitals have been reported to compete against each other to maintain low mortality rates at the expense of low-income patients. Competition within hospitals to see more patients and faster also increases the rate of inappropriate patient discharges. Some researchers and scholars trace the issue of homeless dumping to the issue of homelessness and claim that addressing the issues of homelessness will prevent patient dumping. The increase of homelessness and poverty rates increases the number of people who are unable to pay for consistent healthcare which leads to emergency hospitalization of patients with exacerbated medical conditions. Social factors have allowed homelessness and poverty rates to further increase, and deinstitutionalization has led to psychiatric patients to lose access to services and be dumped on the streets. Intervention strategies The introduction of Medicaid and Medicare had helped hospitals shoulder the burden of providing care to poverty-level and elderly patients, but the many people in United States without health insurance were still vulnerable to inappropriate patient transfer or dumping. Scholars and researchers point to these patients' lack of access to preventative and consistent healthcare treatment as well as inappropriate discharge procedures and follow-up protocols as the causes behind the frequent rehospitalization. In 1985 Illinois developed the Illinois Competitive Access and Reimbursement Equity (ICARE) program, but it had adverse effects like disrupting indigent patient's continuity of care, losing patients, and creating two hospital systems: one for uninsured lower-income patients and one for insured higher-income patients. The ICARE policy had a negative impact on the quality of healthcare that low-income and homeless patients received because it created disjointed treatment experiences when hospitals met their allocated funding quota and transferred patients to (or dumped patients on) other hospitals that still had funding and public hospitals. Proponents of the ICARE policy cited the