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Why American ambulance rides are so expensive

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Re: Why American ambulance rides are so expensive

#231

Post by mc3301 »

ornornor wrote: post #229

I had to call an ambulance in Switzerland where ambulance prices are freely set by the operator (except in a few cantons which are enforcing reasonable flat rates) A 5 minutes ride cost 1500.- (more or less the same in USD) Because I had used a good broker to pick my insurance plan, I was left with “only” 500.- to pay out of pocket for the ride. In Quebec, as a resident, going 3 blocks in the ambulance cost us about…

Yeah, I had a Canadian friend who was in a motorcycle accident. He could see the hospital from where he crashed. He begged the paramedics to let him walk, but they judged he should not.

He was billed 600$.

The paramedics' judgment as to whether he should or shouldn't have isn't the debate here. They likely made the safe call.

Re: Why American ambulance rides are so expensive

#232

Post by socalgal2 »

_DeadFred_ wrote: post #155
pclowes wrote: post #113

Earlier quoted context omitted.

I think what I’m saying is being misinterpreted. I should have been more clear. Everybody’s definition of “taken care of” is different. The government needs to balance the interest of the public with the interest of the individual. It is not intended to “take care of “people regardless of their asks. Otherwise, what if I am only “taken care of” if I have a beachside penthouse in Malibu and also a pony? The government…

Since the 1980s the Republican party had adopted a position of starve the beast, of screwing up these very numbers so that people can make exactly the argument you have. What happens when half of government acts is bad faith purely to poison the well, one half of government and an entire political party make it so that the numbers don't work (and via the fiscal policy they intentionally inflict/structure/design) pure…

The city with the most funds per capita in the USA is SF. It's entirely run by dems. They can't pull it together or make the numbers work any better than repubs

Re: Why American ambulance rides are so expensive

#233

Post by defrost »

gkmcd wrote: post #221
defrost wrote: post #72

Earlier quoted context omitted.

St. John's Ambulance service in Australia is a hybrid of core paid positions and volunteers (varying by region and demand). In rural Australia most of the fire, ambulance, and emergency response service are volunteer manned and (locally) run, with federal and state assistance for equipment and costs. Costwise AU Ambulances are either free (if you're a St. John's member - cheap per annum OR if covered by private / wor…

I don't think this is true everywhere. Queensland has the QAS[1], operated and funded by the state government. There are no (direct) fees. [1] https://www.ambulance.qld.gov.au/

Thanks for the response, it's been awhile since I used an ambulance. I've got to say, I was willing to believe, what with free Qld buses and all that jazz, but alas like WA it's "qualified":

  There's no cost for ambulance treatment and transport for Queensland residents. This includes treatment and transport that takes place in other parts of Australia.
and

  If you don’t live in Queensland, you’ll be charged for ambulance treatment and transport. If you have ambulance cover in another state it may cover the cost for you.
https://www.ambulance.qld.gov.au/our-services/emergency-ambu...

Re: Why American ambulance rides are so expensive

#234

Post by contubernio »

abeppu wrote: post #81

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…

Sharing costs generates institutional incentives to keep costs down. Individualizing costs generates institutional incentives to charge more.

Perverse incentives are the essence of what is wrong with US medical systems.

Re: Why American ambulance rides are so expensive

#235

Post by thayne »

grogenaut wrote: post #170

He refused to go in an ambulance the first time. He could have refused the second ride. You can refuse transport or medical care at any time as long as you are able to make rational decisions. As an EMT if you're A&Ox4, alert to time, place, person and event, you make the choices. You do sign a release so we have proof we didn't abandon you, but you make the choice. If we move you without your approval, it's kidnappi…

I had an accident where I had a concussion and other injuries that put me in a lot of, and the people I was with called an ambulance for me, and I wasn't really in a state to decline, but if I had been, and knew how much it would cost, I would have. The ambulance ride was, of course, out of network. As were some of the doctors that treated me once I got to the hospital. It was the first time I dealt with a major medical expense as an adult, and it came as quite a shock when the bills came several months later, that said I was responsible for about $10,000 for the ambulance (plus a lot more for the hospital), and a good chunk of it didn't even count towards my deductible because it was out of network. I later learned I should have contested that since it was an emergency, and insurance is supposed to cover out of network service in an emergency, but I was young and inexperienced with dealing with health insurance companies. Oh, and it was about a 10 minute ambulance ride.

I guess my point is, sometimes you don't have a choice, but you still end up with a massive bill. And also, that experience definitely had a chilling effect on me calling 911.

Re: Why American ambulance rides are so expensive

#236

Post by conductr »

I spent a lot of time in healthcare finance and across most medical service industries the Medicare rate is actually not a loss. It’s a common thing said as it’s not super profitable, but it’s usually not a huge loss. It’s pretty close to what the cost of care should be. It just doesn’t give the extra padding for extremely fancy clinics, hospitals, admin and executive compensation, and often PE investor margin expectations. It’s usually slightly positive on contribution margin and given the volume of Medicare in the mix there’s enough flow through to cover reasonable overhead and perhaps slim margins. But, whenever I see a claim that the true cost of service is 10x over the Medicare rate, it’s a huge red flag there’s some financial shenanigans at play. Saying that Medicare is a loss, leaves the impression that it leaves a huge hole to fill so other payers need to pick up the bag in a huge way. This kind of lazy analysis blindly perpetuates this misconception. If they wanted to add value here, they should have performed a “what should an ambulance ride cost?” type analysis. You have to really strip out costs that are unneeded, excessive, and account for profit margin similarly. There’s no way $13k makes any sense for the service described. We need sensible cost controls in this industry. The industry hands these people blank checks when they can hide behind out of network, etc. It’s still captive price gouging.

Re: Why American ambulance rides are so expensive

#237

Post by altern8 »

I live in Poland and despite being Europe from what I understand they don't have socialized healthcare. You need to buy insurance from the government, or private (I have both). If you don't have it, you don't have a right to healthcare.

Then, if you go to public doctors or hospital you still have to wait months for an exam or years for surgery. BUT, I've never heard of anyone going bankrupt from getting sick, or being scammed by their insurance not covering costs.

From what people make it sound, in the US you don't have socialized healthcare, getting doctors and exams is quick, but you also get scammed by insurance companies who will try their best to get out of paying, and I've definitely heard about people going bankrupt because they got sick.

Re: Why American ambulance rides are so expensive

#238

Post by King-Aaron »

Here in Australia, you can be 2,000km in the bush and an ambulance will fly out to you and fly you back to the city for free.

That being said, we also have private ambulance companies here that will sting you for a huge bill if you don't have private ambulance cover.

Re: Why American ambulance rides are so expensive

#239

Post by consp »

jjk166 wrote: post #83
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, b…

Here in the Netherlands it is 877 euro for an A1 call (emergency, no delays), and 384 for B1 calls (non emergency, planable). You also get a 4.83 euro per km cost. You pay up to 375 euro if you haven't had any medical cost that year, otherwise zero.

Stand by cost are about 154 euro/hour. E.g. for sport events.

ICU transport is about 2500. All are law mandated.

The total cost might be more as the insurers also put in undisclosed amounts and some cost is shared with the emergency departments at the hospitals.

Re: Why American ambulance rides are so expensive

#240

Post by wisty »

otherme123 wrote: post #212
onion2k wrote: post #205

Earlier quoted context omitted.

I don't think the question is "Should ambulances be a thing?" though. It's a question of "Should someone in a situation where they need an ambulance have to balance the potentially life-threatening impact of saying no versus the potentially financially ruinous impact of saying yes?" The (fairly obvious) answer to that no one should be in that situation. It's horrible. Society should find a better way to pay for ambul…

> Society should find a better way to pay for ambulances Society has this figured out, at least a decent solution that works until we find a perfect one. Only the US society seems to be unable to find a solution.

And the US also pays a TON of tax dollars to a broken, overregulated system.

IIRC if you look at the cost of Medicaide, Medicare, VA, and other federal and state spending it's the same as most other countries per capita or as a percent of GDP. The US taxpayer pays about as much as Canadians to fund their public system, then pays the same amount again for private cover since it's not universal.

No I'm not making a typo. Medicare, Medicaide, and the US system is such a rip off that per capita Americans are paying similar tax dollars to their joke of a public system.

But no one wants to fix it. US doctors are overpaid. US nurses are over paid. Dug companies. Admin. Lawyers. Everyone who makes the system work, and everyone who makes the system a mess are paid a fortune for it.

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