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Why American ambulance rides are so expensive

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Re: Why American ambulance rides are so expensive

#81

Post by abeppu »

Aside from the funding mechanism being a premium that everyone pays, the other part of the motivating story here that seems downright silly is:

- the patient was _forced_ to take an ambulance to another hospital, but not to be treated for anything in particular.

- the post goes into how the EMS system is expensive b/c you need trained paramedics and expensive medical equipment and such -- but sometimes they really do just need to move a patient, not treat anyone in the field or en route. Saying that you pay for the paramedics even when you're effectively just being moved between facilities _also_ seems wasteful.

Yes, we should share the cost. But once we all share the cost, maybe we should try to spend the public dollars effectively by only using ambulances when they're needed, and distinguishing between "transport patient who can't sit upright and buckle a seatbelt" and "try to stop their arterial bleeding as you speed towards the hospital".

Re: Why American ambulance rides are so expensive

#82

Post by cogman10 »

vlian2088 wrote: post #18
darth_avocado wrote: post #7

We’re all pretending this is an unsolvable problem when really most of the world has solved it by making ambulance (EMS) funding similar to fire and police departments. Somehow in any emergency I’ve seen, all three show up, often EMS before police or fire dept, and somehow that’s a service that has to be supplemented by insurance billings. The blog mentions it, but it’s one of those obvious things that somehow isn’t…

the reverse side of that medal is that in 'most of the world' EMS quality is ass.

US EMS quality isn't exactly something to be proud of. It's been private equityified. Just recently (last winter) I nearly lost an aunt because of our stellar EMS system literally doing a transfer from a hospital to a hospice. The company had only one person working, they parked the ambulance next to a snow bank, tried to wheel my aunt up the snow bank, and had her and the bed flip on them trapping them in the snow.

They were super lucky that someone from the hospice just happened to be leaving at the same time they flipped the bed.

Re: Why American ambulance rides are so expensive

#83

Post by jjk166 »

gruez wrote: post #9

As much as I like articles that tries to use economics or finance to explain stuff, the "options" analogy is a bit hamfisted. The article starts off by noting about how ambulance is an "option" for a rescue, but even though the analogy might vaguely work, it's not really needed to answer the question. That can be answered far more simply: "medicare and insurance companies pay them too little, so they have to charge e…

> The average ambulance transport costs $2,673 to provide

I think this ignores the 400 pound gorilla in the room. Why does an ambulance transport cost thousands for the operator? This is a short trip in an automobile, essentially a fancy uber ride. At first one might say that's flippant - obviously ambulances are specialized vehicles, and you have paramedics, and they need to get to locations quickly, and so forth, but let's consider those costs.

A new, fully equipped ambulance is about $150k. Of course this is more than a regular car, but by a factor of 5, not 50. Let's be generous and presume the ambulance fully depreciates in 2 years. Typically an ems crew will be two paramedics. Average paramedic wage is about $23/hr. Again, not orders of magnitude more expensive. Then you have liability, both for the vehicle and for the medical treatment; that's about $12k per year. Throw in money for gas and wear and tear, which should be quite comparable to other automobiles, and it costs about $1600 to own and operate an ambulance for 24 hours.

Now the other side of the equation is utilization. Taking the arbitrary example of Philadelphia Fire Department, they have 60 ambulances that handle on average 700 ems calls per day, and approximately 70% of ems calls lead to transport, so that's about 8 transports per ambulance per day. So distributing this all out, the actual cost to the ambulance operator, ignoring overhead, ought to be somewhere around $200.

I'm sure there are some additional costs I haven't included in this back of the envelope calculation, and maybe some of the numbers I pulled off google are off a bit, this should be taken as a very rough estimate. But even if you significantly increase the cost, the medicare payment amount seems quite reasonable to cover the expenses with a healthy profit margin. Unless you want to claim that operating an ambulance is less than 10% of the cost of ambulance transport, and that the estimators with Medicare are absurdly out of touch with reality, whence cometh $2,673?

Re: Why American ambulance rides are so expensive

#84

Post by darth_avocado »

arjie wrote: post #56
darth_avocado wrote: post #7

We’re all pretending this is an unsolvable problem when really most of the world has solved it by making ambulance (EMS) funding similar to fire and police departments. Somehow in any emergency I’ve seen, all three show up, often EMS before police or fire dept, and somehow that’s a service that has to be supplemented by insurance billings. The blog mentions it, but it’s one of those obvious things that somehow isn’t…

The ambulance that billed me in San Francisco after my accident was run by San Francisco Fire Department.

SF EMS is funded partially through the general fund and other bond measures, with additional billing to cover the rest. I believe it’s like $2K for a ride.

Re: Why American ambulance rides are so expensive

#85

Post by cogman10 »

pclowes wrote: post #79
cogman10 wrote: post #69

Earlier quoted context omitted.

It's very often not a choice. But also, those rural areas are often the breadbaskets of the united states. Taking care of our farmers is important. Trying to frame it as a choice also misses a lot. It technically is, but you have to recognize there's a huge cost in uprooting your entire life and moving to a new location.

We give our farmers absolutely insane subsidies already. It is not the government’s job to “take care of” anybody. Everything has a cost, staying has a cost, leaving has a cost. The question is how much should the public be taxed to pay for individuals suboptimal decision-making? Or conversely, why am I subsidizing some billionaires remote horse ranch to have daily Postal Service and an ambulance standing by? Can I m…

> It is not the government’s job to “take care of” anybody.

That is literally the only job of government. The entire reason we have a government is to serve the citizens in some fashion or another.

Even for most libertarians, they'll view the government in having a role resolving disputes. That is "taking care of" citizens by resolving conflicts.

Subsidizing farmers so citizens continue to have cheap and consistent access to food is a great thing. Right up there with providing clean drinking water, sewage services, and building roads.

Re: Why American ambulance rides are so expensive

#86

Post by gruez »

Noumenon72 wrote: post #68
gruez wrote: post #53

Earlier quoted context omitted.

>The options model matters: if you model an ambulance ride as a roulette wheel, you only expect to pay if you get very unlucky. If you model it as an option, you expect to pay even if you never use it. There are plenty of services that have high fixed costs but low marginal costs, but we don't use the "options" framing. A movie costs tens to hundreds of millions to make, but otherwise costs very little to deliver. Th…

I don't think you fully grasped the concept of an option, which is why it isn't illustrative for you; no one is purchasing the right to see a movie regardless of how much it turns out to cost to show. It's the movie maker that would love to buy an option that makes you promise to buy a ticket, even if the movie turns out bad.

>I don't think you fully grasped the concept of an option, which is why it isn't illustrative for you

I perfectly do know what an option is. It's just not relevant to the discussion, or at least not necessary. If you're selling a service that costs $2k of amortized costs to provide for $300, because that's all medicare/insurance companies are willing to pay, that's not a problem because you're offering options, it's an issue because you're charging too little. You're losing money because the numbers simply don't pencil out, not because you sold a bunch of options and sharp jane st traders cleaned you out. In any other situation where you're charging less than what it costs to provide, people just call it "bad business model", not "you're selling options" or whatever.

Re: Why American ambulance rides are so expensive

#87

Post by gruez »

gerdesj wrote: post #76
gruez wrote: post #9

As much as I like articles that tries to use economics or finance to explain stuff, the "options" analogy is a bit hamfisted. The article starts off by noting about how ambulance is an "option" for a rescue, but even though the analogy might vaguely work, it's not really needed to answer the question. That can be answered far more simply: "medicare and insurance companies pay them too little, so they have to charge e…

Given you find this is _normal_ for a six mile ambulance ride: "and $11,670 as a “base rate.”" What on earth would you consider normal for a helicopter ride from Exeter to London? That's roughly 150 miles as the crow flies. Pilot, co-pilot and a medic, minimum crew for say 1.5 hours. Each way, so 300 miles of fuel and aircraft lifetime and three hours of crew cost, not to mention ground crew etc. My dad got that on t…

> How can that possibly be justified?

They can't make money on some customers (medicare/insurance), so they have to make up the difference however they can. In practice this means screwing over the people who have assets to seize.

Re: Why American ambulance rides are so expensive

#88

Post by dlcarrier »

arjie wrote: post #56
darth_avocado wrote: post #7

We’re all pretending this is an unsolvable problem when really most of the world has solved it by making ambulance (EMS) funding similar to fire and police departments. Somehow in any emergency I’ve seen, all three show up, often EMS before police or fire dept, and somehow that’s a service that has to be supplemented by insurance billings. The blog mentions it, but it’s one of those obvious things that somehow isn’t…

The ambulance that billed me in San Francisco after my accident was run by San Francisco Fire Department.

Many fire departments in the US send bills, whether responding to medical emergencies or fires.

Re: Why American ambulance rides are so expensive

#89

Post by Avicebron »

charcircuit wrote: post #78
Avicebron wrote: post #40

Earlier quoted context omitted.

So everyone's covered unless you explicitly opt-out?

Everyone is covered and you have the ability to pay someone to take on the risk of having to pay for an ambulance.

what happens to the people who don't pay someone to take that risk when they need an ambulance?

Re: Why American ambulance rides are so expensive

#90

Post by defrost »

pclowes wrote: post #79
cogman10 wrote: post #69

Earlier quoted context omitted.

It's very often not a choice. But also, those rural areas are often the breadbaskets of the united states. Taking care of our farmers is important. Trying to frame it as a choice also misses a lot. It technically is, but you have to recognize there's a huge cost in uprooting your entire life and moving to a new location.

We give our farmers absolutely insane subsidies already. It is not the government’s job to “take care of” anybody. Everything has a cost, staying has a cost, leaving has a cost. The question is how much should the public be taxed to pay for individuals suboptimal decision-making? Or conversely, why am I subsidizing some billionaires remote horse ranch to have daily Postal Service and an ambulance standing by? Can I m…

W.Australia has a land area three time that of Texas with the bulk of the 2.9 million in population clustered about the capital city Perth.

In the rest of the state there are volunteer Ambulance services subsidised by state and federal government and a fleet of Royal Flying Doctor air ambulances.

RFD(WA) comes in at ~ $80 million AUD / annum in state support (for better or worse - https://www.abc.net.au/news/2024-07-24/rural-gp-slams-royal-... )

They assert to have a "value" to the state of $4.1 billion AUD over 30 years - https://www.flyingdoctor.org.au/wa/

  Every day, the Royal Flying Doctor Service in Western Australia retrieves 29 people.
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