You want to save money by charging for services, how about a refocus on abuse and unnecessary ambulance runs, rather than screwing over justified need. How about we just learn to cut out the bullshit.
A sobering look at real waste of resource:
In my curiosity, I've asked many people just these questions. A few have tried to tell me that it is just a problem here in America because of "our health care system," although I find some of their reasoning to be fallacious. In fact, a Medline search will yield articles from around the world with many countries trying to grapple with the same problem, including Australia, England, and Japan.
Why do people use ambulances to come to the ER? Before visions of Johnny Gage from Emergency's Station 51 leap to your mind, read this list of common, non-emergent reasons people call an ambulance to transport them to the ER:
• I didn't have a ride
• There was an argument at home
• I thought I might be seen more quickly
• I wanted my family to know I was really sick
• I needed a prescription refill
Just by looking at the statistics at my own hospital, it seems a number of patients use the ambulance simply because they can. I sometimes ask patients why they come to the ER in an ambulance and rarely do they feel that their problem is life-threatening.
Take a look at what one study in London revealed:
• 75,000 calls annually (approx. 16 percent) were unanimously considered to be inappropriate
• 93,000 additional calls (approx. another 20 percent) were considered "possibly" unnecessary
Reported in J Accid Emerg Med. 1998 Nov;15(6):368-70.
That's a huge waste of time, energy, and money. Since I know that an ambulance ride generally isn't very cheap, somebody else must be picking up the tab, if it isn’t the patient.
Even Sweden is not without problems. A June 2007 article found a significant number of EMS transports did not need any pre-hospital interventions, and hence could have arrived safely via many other routes. They recommended that EMS agencies develop clear criteria for dispatch to assist people in the proper utilization of ambulances.( Eur J Emerg Med. 2007 Jun;14(3):151-6.)
So why is ambulance misuse and abuse a problem? To name a few issues:
• Overstaffing of ambulances is needed to weather the burden.
• Patients with real medical problems are forced to wait, and their care gets delayed.
• It is hard on morale for EMS providers if, after years of training, we are relegated to becoming a medical taxi. While driving a taxi is a worthy career choice, it does not take the same level of training, and is an inappropriate use of EMS talent.
• Imagine the waste of insurance dollars on ambulance charges that are unnecessary, or the loss to ambulance companies when/if a patient doesn't pay for their misuse of the system.
How did this happen?
It is my belief that there has been a societal shift over the last 20 years.
• As a society, we have weakened our definition of just what is an emergency.
• We have a McDonald’s mentality — "I want a cheeseburger, and I want it now" — without any delays.
• We seem unable to say "no," in large part because of fears of legal liability if we say no.
• When there are attempts to place reasonable limits of utilization, there seems to be an outcry of "Wait, you can't do that! What about …? It's not fair!"
Why Ambulance Abuse Happens and How to Fix It