It's such a surreal concept to me that having to be picked up by emergency services will cost you money. I feel so incredibly lucky to live in a country where healthcare is free.
I'd rather see the direct or marginal costs of the ambulance or paramedics billed to the user (so, if they expend saline, or bandages, or whatever, you pay for it), and the hourly wage and vehicle costs for the trip itself. That would price a routine EMT-B ambulance trip around $100 -- still enough that people who didn't need it would take a taxi or drive themselves to a doctor for a non-incapacitating problem, but cheap enough that it could be paid out of pocket.
The costs of keeping ambulances ready, training, etc. could be socialized somehow. I benefit by having 5-10 minute EMS response times even if I never use it for 70 years, so paying for that out of taxes or some other universal subscription fee to users makes sense, rather than putting all the costs on those unlucky enough to need it.
In some areas (those with municipal ambulance services), that's exactly what happens.
In my case, I volunteer with a combination career/volunteer fire/rescue/EMS agency. Our 'operating costs' are payed by taxes, but if you use the service, you get a bill ranging from ~$100 for a routine BLS transport to ~$500 for a 'significant' ALS call (lots of drugs and advanced interventions). We don't itemize, but we do adjust billing based on what was done.
My daughter had febrile seizures as an infant. The ride in the ambulance to the hospital was ~$1k, IIRC. I don't think that she was on any sort of IV or anything, but my wife was in the back (I rode up front). (This was in Portland, OR)
If you're prepared to socialise some of it, why not go the whole hog. Is there anyone who thinks that ambulances should e user pays? It simplifies things too, as a fair portion of accidents have a blameless victim, so the cost makes them a victim twice.
The problem is when it's totally socialized (like medicare), you end up with people abusing the service. If an ambulance ride costs you less than a taxi or even bus, and you're an asshole, you use an ambulance (in some places, provided by paramedics, so the direct costs are high -- in some places they also send a fire truck, so you end up with like 20 highly-trained guys and $500k of equipment) to go to a routine checkup. 3-5 times a week.
You could probably waive charging direct costs if you had some other way of deterring abuse, but they essentially always have to respond to 911 calls, so the only way I could think of doing so would be to arrest someone who misuses the service. A policy of informally losing the bill for legitimate calls might work, or doing the standard drug dealer "first one's free" strategy. But I don't think $100-500 for an ambulance would break most people, particularly with insurance; a charity could also cover the bills for some people.
No you don't, because there's no obligation for the ambulance officers to pick you up and take you. A taxi is in the business of taking anyone they can anywhere they can. An ambulance is not. The only time they'll offer you a ride is if they judge that you may need of it, so already qualified ambulance officers have deemed you a possible candidate requiring their services. Moreover, they've only got one destination - the hospital - and it's not as if many people want to go there willingly. It's not as if you can call up an ambulance to pick you up and take you down to the pub for the night. If the ambulance officers are qualified to recognise medical emergencies (they are - that's their job) then they're qualified to determine who requires ambulance transportation and can filter patients accordingly.
The problem with 'a charity covering the bill' is that you then need people to donate out of goodwill. That doesn't often happen.
There's already fines and punishment for abusing emergency support systems (e.g.: calling 000/911/your country's equivalent). Even if you abuse that, and even if you mislead the call centre operator to dispatch an ambulance to your house, they're not going to ferry you to your desired location unless your vitals show reason to consider it a possible requirement.
Ambulance services are free here, insofar as you pay for a small tax on every rates bill (said rates cover ambulance and waste management services) edit: Apparently not since 2003 - it's now simply just covered by the State. There's no out-of-pocket expense. I can guarantee you that we don't have ambulances running people not requiring their services around 24/7.
I can confirm this, works just fine in Germany and ambulances are free (i.e. covered by mandatory health insurance). And even if it would be abused - which I really can't imagine - I'd much prefer 100 idiots free riding to the hospital to one person dying because he can't afford the trip.
I was always told that here (Austria) if you call the ambulance but are not in actual danger you have to pay for it, and that it's very expensive.
But you can call an emergency physician if you're not sure if somethings wrong which is free in any case afaik. They will examine you and make a determination if you need to go the hospital.
My mother once called them because she was concentrating so hard on her heartbeat while trying to sleep that she started to panic because she thought it wasn't beating normally. The emergency physician examined her and deemed everything normal, made her calm down, and then just left. I was told if she had called the ambulance it would have cost a lot.
That's not true at all. If you call 911 (or someone calls for you), and you don't want to go to the hospital, you have to sign a form saying we offered to take you, but you are choosing not to go.
As rdl pointed out, the liability is just too high to refuse to take someone to the hospital.
When I lived in the UK, I called for an ambulance. The responder listened to my situation and told me I didn't sound high enough risk, so I got a taxi. I didn't get the sense this was unusual.
However, it wouldn't surprise me if the liability issues were very different in the UK.
Even in silly Poland (not to speak of Netherlands) abuse of ambulance service is treated very seriously. If the hospital makes the case that you made a call either as a prank or frivolously, you're in a world of trouble.
The argument isn't that they shouldn't get care, or even that they should have to pay for transport, but that they should be guided (using cost incentives, in the US market model) to use the most appropriate transport. ALS, BLS, mobility-but-not-EMS, or taxi). The problem is there are a lot of places in the US where "take an old person to see a doctor for a checkup" requires using BLS or even ALS ambulances, which is crazy, because ambulance would be covered but taxi would not be. It's better to just give these patients taxi vouchers, if you want the government paying for it, for $10-20, vs. a $100-500 direct-cost ambulance ride.
There's a separate argument about who should pay for what services, but "care should be delivered in the most cost-effective way to get the best patient outcomes" is independent of that.
The liability for refusing to transport a patient to ER who claims certain symptoms would be huge. Even doctors won't make that call in the US; there's no way an EMT or paramedic would.
And, if they're evaluating you on scene, even if they decide not to transport, they've already rolled the truck(s) to see you, which is probably much of the cost.
Some wilderness rescue services have an interesting take on it. If what you were doing was really stupid (like, hiking up and skiing a mountain in the middle of the night, during a storm), they bill you, but if you really just got screwed (fell and broke your leg), it's free.
I also think if you got "saved" by wilderness EMS, and were in a position to do so, you'd probably really want to donate money or other resources (time? promotion? something) to thank them.
A lot of patients need to go for visits with doctors at the hospital or in an associated complex. Many of those patients don't need special medical transport, or at the very least could go with BLS, but there are places where ALS gets used for everything and thus is very expensive. Medicare patients don't see this, but the reimbursement from Medicare to EMS is very small, too. If you have a substantial elderly or sick population, it can be a real problem.
If you talk to EMTs you'd find most calls are for elderly people with heartburn. Yes, some people abuse the system. Maybe offer one free ride a year or something.
In SF it seems to be a small population of seriously mentally ill, drug addicts (both OD and drug-seeking), those with ongoing conditions which they fail to manage properly, etc.
There probably should be a cheaper way to treat them than sending SF Fire over and over to the same addresses. And that way would probably be both more comfortable for the patients and lead to better long-term outcomes. Maybe more extended inpatient care for them (in a low-cost-per-day facility)?
These has got to be some sort of war-on-drugs or drug policy thing going on here. Why is this so bad where you are, while it isn't a massive problem where I am (New Zealand). Sure there are drug problems (Meth and alcohol are hitting headlines too often), but you rarely seen the sorts of scenes I saw on a brief visit to SF.
SF ends up with drug addicts/mentally ill from an area of maybe 30-50mm people, due to what are perceived (correctly) as more welcoming city services, culture, etc. Add to that the war on drugs and weird issues with medical care for the poor (medi-cal), lots of Vietnam era veterans, etc., and one of the most dysfunctional city/county governments I've ever seen. (Detroit and New Orleans are worse, but those cities are poor; SF is rich).
I do not mind paying some taxes so that anyone can get help when they need it. The thought 'Do I have enough money to call an ambulance?' should never be something someone should consider. If you need emergency services you should be able to call and get help.
But I do understand what you are saying, I just do not think of it as spending money as my taxes most likely would not change regardless, they would just be used for something else.
In the US right now "spending marginally less money" probably means "borrowing marginally less money", which would actually be good. I don't think taxes would be lowered in response to cost savings, but deficit borrowing might be.
I am not a crazy anti-healthcare nut as this comment will make me appear, but I think you mean "healthcare is paid for by others/collectively", since it isn't free to provide services, unless your doctors are working for no money.
There are 7 billion people on Earth right now. You are going to find some that don't know what the hell "breathing" means if you just try hard enough. Using this to pick apart at the word "everyone" is just as pedantic as picking at the specific definition of "free" in that question.
Even more, in most systems I know the amount paid for health insurance is fairly explicit. Where I live you actually get a bill from a non-state company (some things may be subsidized from other taxes, and if you can't afford it you also get a subsidy, though) so no, people don't think it's "really-really" free. It's "people with more money contribute more".
I'm afraid breathable air does cost you the energy required to operate the lungs. This energy is mostly generated from digesting organic matter such as vegetables and meat which can vary in price. Free cannot exist since we live in a universe with entropy. In other words in any given system some energy (cost) is lost.
I thought you explained it perfectly yourself, but sure. You were not addressing the original point about breathable air being free. Instead, you built a straw man, based on the presumed cost of /breathing/ it, which actually had nothing to do with the original point.
By the way, if you want to be as anal about the definition of "free" as to include totally peripheral expenses (as if a pencil costs you $100 for signing a check with it), you might as well get to the bottom of it and say that everything is free on the basis that no matter or energy is ever expended.
The quick response times our ambulances achieve are due to their being strategically placed around a city, manned and ready to go.
It works this way whether you're talking about a city-owned ambulance at the fire station or a privately-owned one idling in a parking lot somewhere. In either case, you (or your insurance, or your city, or your state...) are paying for a driver and at least one paramedic to sit around at the ready, not just for the quick trip.
I don't think that doesn't make any "economic logic", for lack of being able to remember the correct term.
If that were true - if the price was based on the cost - you would have small towns & rural areas where it would be so expensive, no one could use them, and cities where even though there were more ambulances, EMTs, etc, the cost would be spread so thin as to be barely noticeable
I don't believe the price is tied so directly to cost of service
It's hard to make out exactly what your point is but you're correct if you're trying to say that the price here is not simply about supply and demand. The costs of ambulances are subsidized in many ways (but they're never "free") and you're also dealing with people who generally don't have the ability to shop around. It's not a "market" item, really, on either side of the transaction.
Regarding rural areas and small towns: they often keep costs down by having crappy medical services in general, and slower response times specifically. It's not always that bad, though. If a town isn't sprawled out response times shouldn't suffer so much.
I don't want to push this next claim too far, as I only have "I have heard" to back it & no actual numbers or links, but...
I have heard on more than one occasion that the reason emergency services (ambulances, ER, etc) are so expensive is to recover the cost of all the uninsured users.
People can be refused at a clinic if they have no insurance, so they go to ER for everything, where in many places they cannot be turned away. Hospitals therefore have to bill YOUR insurance to recover these costs
You are assuming too much: my ambulance ride isn't expensive. I live in a municipality which provides its own ambulances. In a geographically dense suburb it's efficient, logical and cheap (relatively) for EMS services to piggyback off of fire services. There aren't enough free riders around for the system to fall over from the "uninsured." If you're around here, you've probably helped pay for it.
> Hospitals therefore have to bill YOUR insurance to recover these costs
You know who takes an even bigger hit? Uninsured but solvent patients. Insurance companies have greater bargaining power.
None of that has anything to do with the ambulance business.
When you consider all the costs involved, it's not so unreasonable. You've got the cost of the ambulance station, ambulance itself, equipment, maintenance, fuel, medical consumables, paramedics, technicians, etc.
You're not only paying for the time you spend in the ambulance, but for the paramedics to be on standby, and for technicians to clean and prepare the ambulance for its next trip afterwards.
Wow. Maybe there are legal or labor expenses way over what we have in South American countries.
I've heard that a lot of medical expenses in the U.S. are due to the high amounts of litigation (I still can't believe the stories of healthcare costs in the United States).
There must be a difference in ambulance spec too. How do you compare this? Can I confirm that the earlier comment of yours meant $14,000USD? I can't read Spanish unfortunately. Thanks.
I grew up in a country (Canada) where healthcare was free, but you still paid for emergency services. The two are not the same, and there is a real benefit to discouraging the unnecessary use of ambulances.
> It's such a surreal concept to me that having to be picked up by emergency services will cost you money. I feel so incredibly lucky to live in a country where healthcare is free.
We have a (very good) public healthcare system here in Australia; but an ambulance will still cost you.
Not for people in Queensland. It used to be rolled in to our electricity bill at $24/quarter but that was abolished a while ago (apparently 2003). We're now just covered simply by living in Queensland for ambulance transport anywhere in Australia (that is, if I need an ambulance in Victoria, I am covered by the State) [1].
I'm in Vancouver. I got hit by a cab on New Year's and had to pay $80 for the ambulance. The cab's insurance is picking that up, despite the whole ordeal being my fault, so they're sending me a check for $110 then asking me for $1500 back. Go figure.
In my country, ambulances are free for only life-threatening cases, but most everyone pays for an Emergency service (ambulances and walk-in ER), which costs U$ 15/month.
FYI, where I am, people other than pensioners pay a small annual registration / insurance fee to the ambulance service to avoid large fees upon use of the service
Someone always makes this comment. It's unhelpful as the meaning of free is clear. It's the same kind of free as the bank bailout. It cost you nothing and a hell of a lot at the same time.
>picked up by emergency services will cost you money
It does cost you money. Europe plays a different game than the US but both are games. Thanks to Kennedy no one can be turned away from the ER for lack of insurance and bills are paid off later for cents on the dollar if you have no assets. If you have assets and no insurance too bad.
> Thanks to Kennedy no one can be turned away from the ER
Which is funny, since they're only required to "stabilize" you once you're there. I know a guy who was attacked, suffered head injuries, and couldn't remember who he was. He was patched up and discharged in that condition since he didn't have his insurance card on him (and, I assume, since a shirtless and beaten-looking guy with long hair is just assumed to be homeless).
I am quite certain that behavior isn't typical of the hospitals in our area, but I bet it's totally legal. And a valuable cost-saving measure! An MBA somewhere is surely proud.
