Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Why American ambulance rides are so expensive

davidoks.blog

Post reply on HN
Print view View original

361–370 of 536 posts

Re: Why American ambulance rides are so expensive

#361

Post by getpokedagain »

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…

>> 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.

Disagreed. Someone who is cogent and not intoxicated and not a stroke victim can't always make the best choices. Your decision making can be compromised by I dunno the fucking pain of a broken toe bone.

Seeking help should not be interpreted as a sign of weakness and made into a maze where only the most rational can escape with minimal bills. The longer we leave this cognitive dissonance where the land of the free roughly translates to land of the free to get fucked we are going to continue to have instability.

Re: Why American ambulance rides are so expensive

#362

Post by closewith »

Ntrails wrote: post #319
pshirshov wrote: post #293

I worked at a company which was doing medical billing for ambulances among other things. Essentially, the bills are always inflated so when the settlement comes the providers get 20..50%. The crucial procedure is so called "medical coding" where medical notes (sometimes - scrawled on paper with a pencil) are being turned into bills - and that's where additional codes are getting added and more expensive codes are sel…

> an average helicopter bill was smth around $200K if I remember correctly, with spikes up to $500K. Those numbers made me blanch somewhat! Having been in a helicopter (aka Air Ambulance) in the UK, all of which operate as charities iirc, I was curious about their costs. > The average cost of a helicopter mission is £4,748* and the average cost of a critical care car or rapid response vehicle mission is £2,054*[1]. h…

I tried to find the asterisk there to see the details, but could not.

FWIW I think that HEMS cost is significantly under costed, as the London HEMS H135s run about £2,500 per flight hour on direct flight costs alone, so I suspect the £4,748 figure is referring to that alone.

I think a closer estimate is probably total annual operational costs divided by total shouts, (£18 MM / 2,000) or about £9,000 per shout.

Even that's an under costing, as the clinical personnel, equipment, and liability is shouldered by the NHS. A pure costing is probably closer to 2-3X that per clinical flight.

Still an order of magnitude less than the commercial US operators.

Re: Why American ambulance rides are so expensive

#363

Post by testing22321 »

xp84 wrote: post #22

I tell this story every time ambulance costs come up because it might be helpful to anyone. I once lived in San Francisco in the mid-2010s. In SF, the SFFD operates the vast majority of ambulances in the city. As in, 80%+. I once had the need to go to the hospital urgently and called 911. The ambulance that showed up was SFFD. They transported me and I recovered safely. I then got a bill from them saying that my insu…

Unreal you have to go through this in the richest country in the world.

Family members have been in ambulances a few dozen times over the decades. There is no concept of a bill or paperwork for it. Like borrowing a book from the library.

Re: Why American ambulance rides are so expensive

#365

Post by alistairSH »

true_religion wrote: post #276
sitharus wrote: post #222

Earlier quoted context omitted.

Really? Where I live a patient is always able to refuse any medical procedure or treatment, unless they’re unconscious or otherwise mentally unable and the procedure is considered necessary to save their life. They certainly can opt for a non-ambulance transfer, though here it would be free even though a regular ambulance service typically isn’t. Consent for treatment is a core principle of medical practice.

I think the idea is that if it's mandated, then the ambulance should be covered by some kind of insurance since it was medically necessary and not just Ol' Bob, the hypochondriac, calling because his tin foil hat fell off.

Except that's not how it works. Ambulances are almost always out-of-network, so subject to MUCH higher OOP expenses. It's spelled out in the article.

Re: Why American ambulance rides are so expensive

#366

Post by nekusar »

pjc50 wrote: post #342
cucumber3732842 wrote: post #309

Earlier quoted context omitted.

>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. 17% of GDP is healthcare. So between 1:10 and 2:10 people in this country are making more than they otherwise would (note I did not say wealthier) because the system is screwed up and hoovers up more of eve…

Possibly reasonable point about labour supply ruined by an absurd analogy with slavery.

Not at all.

Systemic inertia is unimaginably strong.

I easily see that changing the USA to be more socialist, especially in areas where game theory indicates its the best solution, will likely take a civil war.

That also aligns with Marx's writings, that the capitalists will not acquiesce without a fight, and a big fight at that.

The slavery and Civil War connection is a comparison of similar economic magnitudes.

Re: Why American ambulance rides are so expensive

#367

Post by alistairSH »

anonym29 wrote: post #336
pshirshov wrote: post #293

I worked at a company which was doing medical billing for ambulances among other things. Essentially, the bills are always inflated so when the settlement comes the providers get 20..50%. The crucial procedure is so called "medical coding" where medical notes (sometimes - scrawled on paper with a pencil) are being turned into bills - and that's where additional codes are getting added and more expensive codes are sel…

$500k? There entire helicopters you can just buy outright for less money than that. Does the $500k ride come with the helicopter itself included in the purchase?

Uh, a new Bell 407 is north of $4 million and that's before it's equipped for medical flights. You aren't buying one of these for $500k used, at least not one that's air worthy. Eurocopter EC135 are a bit cheaper, but not by much.

Re: Why American ambulance rides are so expensive

#368

Post by cpursley »

philipallstar wrote: post #327
bestouff wrote: post #296

Earlier quoted context omitted.

I think only the US consider the US Democrats as leftists.

[flagged]

Pretty much the entire “New World” has birthright citizenship, so it’s not just the US thing and I don’t believe its origins are political at all.

Re: Why American ambulance rides are so expensive

#369

Post by closewith »

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…

> A new, fully equipped ambulance is about $150k.

This is definitely not true. A base model unequipped ambulance may be in that ballpark. A fully equipped ambulance will vary wildly in cost based on clinical level but will be about $250-500k in the US.

> Then you have liability, both for the vehicle and for the medical treatment; that's about $12k per year.

Maybe for BLS or non-emergency ambulances in a low-utilisation role? For ALS/Critical Care or higher in a busy jurisdiction it's going to be significantly higher.

Re: Why American ambulance rides are so expensive

#370

Post by [deleted] »

uoaei wrote: post #315
cucumber3732842 wrote: post #309

Earlier quoted context omitted.

>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. 17% of GDP is healthcare. So between 1:10 and 2:10 people in this country are making more than they otherwise would (note I did not say wealthier) because the system is screwed up and hoovers up more of eve…

Earnings represented by GDP are not distributed evenly across a given population. That 17% of extra earnings goes to relatively few people in the States (I'm putting this very mildly, the concentration in reality is insanely lopsided).

[deleted]
Post reply on HN