Another problem with this article and the metric being used- Advanced medical care starts the moment an ambulance arrives. Modern EMS brings the hospital to you. Most ambulances with lights and sirens on are going to the call, not the hospital.
The diagnosis and treatment starts the second they arrive, so you can't compare that to waiting in the ED or to your 5 minute taxi ride. 5 minutes not breathing is 5 minutes too long.
Also a lot of billing comments are coming from the two types of ambulance services in the USA : Emergency and Transport.
The closest thing to a taxi in the USA that is non medical is an ambulette - a taxi equipped for wheelchairs and disabled passengers. The driver is not a medical professional and there are no medical capabilities. A lot of transports can be done via ambulette. Meanwhile 911 times need to be measured from crew arrival at the scene. not time to hospital.
1
"Disrupting the transportation market" isn't necessarily a good thing if some of the ambulance are carrying people who are in having emergencies and are in danger of dying. Are we worrying about ill or injured people or "the market" here?
1
"By 18 months after the expansion (of ACA coverage), ambulance dispatches for minor injuries were up 150 percent."
People really need to have some skin in the game before they realize they are wasting someone else's money (and resources) for no good reasons. This is exactly the kind of wastage that ACA (and the country) and do without, the resources of which could have been used far more productively in other genuine life-and-death matters.
2
@tiddle It’s not a problem of the ACA itself, it’s with its implementation of it, you either have copay or deductibles in place to avoid misuse of resources.
1
And when you get to ER, on an ambulance you can afford to pay for, remember your insurer may well refuse to pay if it was the “wrong” kind of emergency. That is, if you live the “wrong” state where the “wrong” kind of insurer is piloting this kind of initiative. No joke.
2
Except, in the case of a demented father, who chose an ambulance because it gets him right in and no waiting in a cold emergency room.
In no other first world country do ordinary citizens in acute physical distress beg strangers not to call an ambulance because they can’t afford it.
For shame America.
9
I think that, without a list of "minor emergencies" for which a cab or Uber may be appropriate, this article is irresponsible. "That tightness in my chest is probably just indigestion, but I want it checked out. That nice man from The Times said I should just call and Uber for something minor like this."
I do, however, feel that people need to use a degree of common sense. A cut needing a few stitches? A sprained ankle? Uber is probably fine.
2
@10034, What are you talking about? A sprained ankle is NOT emergency, not even a minor one. Uber is not just "probably" fine (in your words), it's what it should have been.
2
All quite true but small change in comparison to the cost if you get hurt in a rural location.
""Do not get on an emergency helicopter unless you are going to die in the next 45 minutes.""
It can cost upwards of $30,000.00. I live in the Catskills and I can tell you that the first responders, volunteer firemen, love to call for a helicopter if your banged up good or even a little. Why, cause everybody loves helicopters. Nothing makes a guy feel more important than setting up to land a chopper. Unless your way out in the Rockies and there's no roads or it's a three to four hour drive to a hospital do not let them do this to you. Most insurance will not pay for this.
2
sure, if I thought I was dying I would take an uber rather than an ambulance because it would save the insurance company money. I don't think ubers have advanced medical capabilities but hey, it would increase insurance company's profits..
6
@poins, The article has already answered your hypotheticals: "By 18 months after the expansion (of ACA expansion), ambulance dispatches for minor injuries were up 150 percent." This is not a case of "I'm dying" or trying to "save a buck" for insurers, it's a case of "it's free, so why not?"
2
I recommend that if possible, first establish a file with your insurance company. You can do this by calling the emergency nursing line (if your insurance company has one. Mine does.) Explain your symptoms and get the nurse to recommend ambulance, ER on your own, or whatever. By starting this file (again, only if possible. It should take only a few minutes but do not hesitate to call 911 and use an ambulance if necessary) the insurance company has a record that you were instructed to go to the ER, and if you call an ambulance you were instructed to use an ambulance.
I have done this a few times and it really cuts down on insurance arguments. I even once called and by the time my husband drove me to the ER the insurance nurse had called and it sped up intake tremendously (essentially triage had already been done).
I loathe insurance companies but I figure as long as they are a necessary evil you might as well work with them as fight them.
10
I recommend moving to any other first world nation, where emergency care is considered a public service, not an opportunity to bankrupt a vulnerable citizen.
3
A high percentage (if not the majority) of ambulance rides are paid for by Medicaid. Many of those patients cannot afford even a $15 or $20 Uber or Lyft. Rideshare apps also require a credit or debit card, which many Medicaid patients do not have.
5
A recent Uber commercial had multiple scenes of different people in varied situations flash by, using Uber.
One of the scenes was a pregnant woman and her husband rushing to the hospital (we're assuming).
I nearly fell out of my seat. I hope Uber drivers are trained for childbirth.
2
@d. stein I drive Uber and Lyft. Sorry, but unless you can prove that her water has broken already (Mom of three here) and that my entire day will not be ended because of ruined seats, I will be sitting at your house telling her not to push while we wait for the ambulance!
1
@merzydoats
EMS will deliver the baby.
I am 71. When I had a violent late-night accident (while doing the laundry) last year and had an open, bleeding, unstable fracture of a finger, I just grabbed my purse, put on my shoes, and went out and hailed a yellow cab. It cost me about $10 to get to the NYU ER and was also a lot faster than waiting for an ambulance in Manhattan (if I could have gotten ambulance, as they often resist sending one if you haven't been shot in the head or had a stroke). Fortunately, I was able to put off fainting until I got to the ER.
13
@ellienyc Thank you Ellie, I appreciate your taking care of your own transportation for a painful but not life threatening medical situation. I can't tell you how many times I have wished patients had taken a bit more time to think before calling 911.
2
I stabbed my hand by accident in the kitchen at midnight . My husband immediately called Uber so we could go to my preferred hospital (which has all my medical records). I felt weird about bleeding in someone’s car, but my finger was wrapped in paper towels at that point and the driver understood the situation.
2
@ellienyc I am so glad to know this worked for you. While dealing with life's smaller injuries, I have often thought that all I need is a ride to the place I can get care.
2
It is outrageous that anyone would suggest hiring an amateur driver to go to a hospital, when any medical situation could suddenly escalate into a life or death situation. That is why we have ambulances. Professional skill is required. The only other option is to have triage emt's on call to decide whether or not ambulances are required, but that would delay care. Here, the Fire Department sends out crews to make that call. All ambulance rides should be covered by insurance, no matter what. And the service providers must keep their fees reasonable, no more than a 10 percent profit margin.
4
@Grittenhouse
I have to disagree. Not any medical situation could suddenly escalate. We get 911 calls for every little nothing you can imagine. People want to go to the ED because they are out of their prescription; they need a small amount of stitches; they twisted an ankle; carpal tunnel exacerbation; threw up once; and the list goes on and on.
The 911 dispatchers are supposed to begin the triage process but they can only go by what they are told and many jurisdictions follow the "you call we haul" practice which assures billing dollars and crowded emergency departments.
3
@CMK
Wow, I'm shocked that people would try to request an ambulance for those kinds of things. There should be a way to triage them over the phone, but then I guess there would be situations where the injury unexpectedly became life threatening and they would get sued. Or people would just lie and say they're having a heart attack no matter what the problem was.
This article deals with two major social disfunctions that intersect: health care finances and the way Uber has destroyed the value of taxi driver labor. Both could be fixed with good government, best practices, rational regulation that sets a level playing field, etc., but our government doesn't seem to be able to get those jobs done, and is flat-footed competing with nimble tech disrupters or with long-known problems in health care structures. Of course, I blame the right for not wanting to make government what it could be: an aid to everyone.
9
@Daniel Mozes, to be honest, if cabs just as well as uber, I don't think it could even exist. Ride-shares like uber and lyft exist because the market likes them. Every one of the 20- and 30-something in my workplace use ride-shares; no one even considers calling a cab. THAT is not something "good government" (as you call it) can fix. It's called "market demand."
As to healthcare finance, the article quite aptly answers your question already: In the 18 months after the expansion of ACA coverage, use of ambulance for minor incidents shot up 150%. Well, I don't know about you, but as a taxpayer, I don't want to be wasting precious resources on such abuse. But these users don't care because they don't have any skin in the game.
2
Uber and Lyft drivers are not peoples personal EMT's. What the hell are your family members for?
4
@Snooty Some people don't have family members, especially in cities. I live in Manhattan, am over 70, and hailed a yellow cab when I had a nasty accident last year that resulted in an open, bleeding, unstable fracture.
10
Did the taxi driver splint your fracture?
1
I was in a car accident this past May, someone made a turn in front of my 55 mph speeding car. I slammed on the brakes and started swearing...The ambulance wanted to know if I wanted to go to the hospital, I was alert badly shaken and had a big bump on my leg that was hurting. I didn't know what to do? I waited till the police handed me back my id's before I went in the ambulance. My car was not drivable and even it if was I did not want to drive to the hospital, as I was still quite shaken. I was lucky nothing was broken except the car (totaled). And am happy I went in the ambulance, excellent crew, caring....my plug for EMT's!
2
@walking wounded I would likely have told the cops I'd rather take a cab. Or maybe just call my personal doc before I decided if I even needed the ER. I don't know what ER they took you to, but the wait can be endless, even when you arrive in an ambulance, if you are conscious and haven't been shot in the head or something.
@ellienyc
I do not live in NYC and there are no cabs, I wanted to make sure I didn't have a broken bone. I was so shaken, I could barely stand, let alone make a phone call. I was taken to a local hospital,wait was minutes, here 50 miles north of NYC... have you ever been in a car accident? Its' traumatic!
1
Imagine if we charged for police and fire the same way we do for ambulances.
6
@Pete
I wish I could see that world. Ironically, in NYC at least, EMS is paid Much less than those two agencies with far fewer benefits. Maybe just bill the same for those 3 digit calls?
@Pete
That's insane. I lived in an apartment that had a major fire from an electrical wiring problem. Had my neighbors not called 911 the whole building and the whole block would have quickly gone up in flames. A similar fire happened in a similar building in the neighborhood a week later where multiple people died because it started at night and the 911 call was delayed compared to when the fire started.
What a bizarre and disturbing story from a dystopian world. Ambulances are free in Germany and probably in all other developed countries. What cruel political system might put private profit motives ahead of immediate emergency care? Why isn't this a public service like the police or fire department? It's not rocket science. And it's not even remotely as costly as claimed, if managed properly. I wonder when the American people will eventually wake up.
41
@Andre
Depending on the state, we don't even have fire as a public service. In low tax states people have to pay a "voluntary" fee to the local fire department. If they don't or can't afford to then the fire department won't even try to save their house. My uncle is a volunteer firefighter in one of those states, it's so sad when they are not allowed to help because someone couldn't pay their bill.
6
Many ambulances are manned by volunteers in the USA. However with the lack of folks volunteering sadly paid ambulances are on the rise. Cities are mostly paid crews.
1
@JJ
it is also not possible in a city. we can't have 2 billion in property go up in smoke and rubble because the fire started in an apartment that didnt pay the fire bill.
In a country that brags repeatedly to the world and propagandizes to its own citizens how wonderful their quality of life is compared to elsewhere, more articles should be published in the Times about how shockingly inadequate it is that the US healthcare system offers so little to its citizens, that they are left paying out of pocket their own emergency ambulance costs more than half the time. And now people are being discouraged to call an ambulance and told to take a car service instead. Really? How many first-time heart attack victims will lose critical time second-guessing themselves when they should simply call 911. Rather than try to retrain people, the "richest nation in the world" should step up and give its people a healthcare system that leaves them proud and healthy, rather than sick and bankrupt.
23
@Mary It is my belief that in high school and periodically there after, there should be classes on how to interact with 911, police, fire and emergency medical services. Unfortunately rather often first time heart attack victims don't call anyone and don't go to the hospital by any means. While I agree the U.S. should bolster the healthcare system, currently in some american cities, emergency medical services, (what you will get when you ask 911 for an ambulance) is highly overloaded. EMS is expected to deal with every person sleeping on the sidewalk, and every person who wants to ride in an ambulance. This leaves at least one american city occasionally with only 2 or 1 or no ambulances available. When an ambulance picks us some person who jammed their finger to take them to the hospital, if a life threatening call comes up, perhaps the first time heart attack victim who does call 911, that ambulance cannot discharge their patient on to the street and respond to the person who needs CPR and paramedics. That person waits until an ambulance becomes available. Sometimes that wait is too long.
1
Many years ago, when I was very young, I sliced open my thumb to the bone. I knew it had to be stitched up, but didn't want to take an ambulance. I was kind of freaked out, and I made the mistake of using the word emergency when I called for a taxi. But by policy or law, not clear, they refused to do an emergency call. So my advice is that if you're going to call anything but an ambulance for a medical emergency, don't use that word.
8
@rbyteme I recently had an accident and ended up with a broken, open, bleeding thumb. I wrapped it in a big towel, put on my shoes and went out and hailed a yellow Manhattan cab, I just told him where I was going (the NYU ER) but not why, and had no problems.
5
@rbyteme
When I was two I fell and bit my lip almost entirely off. I was gushing blood. My father had little money and ran with me all the way to the hospital because no cab would stop for that mess...
1
For some reason I thought ambulances, like fire trucks, were emergency services for the community paid for by the residents’ taxes. One of the few taxes I would not mind paying.
However that is not the case and I found this out when a fellow equestrian had an accident at the stable. I found her on the ground with a concussion. When I said I’m calling 911, she begged me not to, as the cost would be excessive and a burden for the family finances. I had no idea. Something does not seem right here. Of all the taxes we pay and this is not covered!
20
Ambulances are not "free" under Canadian medicare although I think they maybe to.welfare recipients in BC. I think the fees are less than in the US of A.
4
Someone, as a prank left two marijuana laced cookies on my desk, which I ate. A 911 call was made, not by me. I explained the situation to the two paramedics, who decided to take me to a hospital to sleep it off there.
Columbia Presbyterian, literally a 2 minute walk away, charged me $1,598 for the ambulance ride. (The cost to lie in the hallway and sleep was another $5800).
I said no to the ambulance, but was ignored. No treatment was administered. An Uber would have been more than adequate.
6
@Ikebana62 You could have had an allergic reaction and died.
I suspect this article was paid for by Uber and Lyft.
A factor not considered but reported by my ER nurse wife. You will be seen faster and potentially be taken more seriously if you arrive at the ER in an ambulance than if you arrive by private car.
11
@fairfieldwizard
I don't know where she works but please don't spread that as truth everywhere. I have taken patients straight to the waiting room after their 911 call. So they got an ambulance bill for a trip to the waiting room with everyone else. Of course they were not emergent patients. I've worked the front desk of an emergency department and had people walk in who were driven by friends/family and we have whisked them to the back because of their illness or injury.
4
The author negligently fails to emphasize that there are times when taking an ambulance is critical. For example, if a person is having a heart attack, getting proper medical attention as soon as possible can be the difference between life and death. The ambulance will not only get you to the emergency room faster, if you come in an ambulance you will jump the queue at the ER. All of this was explained to me when I feared that I was having a heart attack; luckily that was not the case. But, if you have a serious and urgent medical situation like a possible heart attack, taking a ridesharing service to the hospital is just plain dumb. FYI I have no affiliation with any part of the medical establishment.
19
@Tim
I agree with you fully. Last year, my colleague's husband took an Uber to a doctor when he wasn't feeling well and subsequently had (or was having) a heart attack en route, had to be transferred to an ambulance and was DOA at the hospital...all while she tried to find him since he didn't show up at the doctor's office she was to meet him at...and he wasn't answering his phone. It was incredibly traumatic for her (and even me back at the office helping her try to find out what happened to him, where he was taken, etc.) since initially Uber wouldn't reveal where he had gone. An ambulance is critical for someone in these circumstances -- heart attacks, strokes, etc.
7
I agree that this article could have been more helpful by explaining what types of trips the researchers deemed necessary vs. unnecessary. I found myself wondering what trips in ambulances are considered frivolous, since I think of them mostly in situations like heart attack, car accident etc.
4
@Tim
All of that is correct. But please, if it is a minor matter do consider alternative transportation. And consider an alternative destination. Laceration that stops bleeding after 5 minutes? Try an urgent care or other facility.
4
The other day, a pediatric patient at my office needed to travel to the ER for an evolving severe allergic reaction. It was too severe to send him and his mom in the car alone. But I did not want them to have to pay for an ambulance ride, and also have all the relative emotional trauma of that hubbub, particularly for a child. So I paused my clinic, rode to the ER with them in their car, with epipens in hand if needed, and had my secretary follow us and bring me back to the office afterwards.
What do you all think of that?
23
@Doctor I think that sounds extremely improper and irresponsible. I'm an EMT and that goes against everything I was taught. What if he had needed oxygen? Or more powerful medication? An epipen is a first line of defense in an emergency, nothing more. Also, if you are actually a doctor, you should be aware that anaphylaxis can return in as short a time as 10 minutes after epi administration, making it critical that those patients reach the hospital as quickly as possible. What if you hit traffic?
Since this is the internet and anyone can lie about their credentials, I tend to question whether you're a physician at all.
5
@Chris:
I suspected someone would find a way to object.
Selfless, caring, sacrificing self-interest on behalf of the patient (losing $ by leaving the office), going above and beyond, etc.
-versus-
Improper, risky, what if’s, etc.
Both are valid considerations. If the kid died, I could have been judged.
But yes, I am truly a doctor, and I did actually do it. It was a decision, like so many others. Pros and cons each way.
I was correct in my estimation that we wouldn’t need any oxygen or other meds, and of course I know the duration of epinephrine (didn’t you see my plural?), and I saved them the cost of the ride.
As an EMT, naturally you are trained to think the ambulance is the only way, and discourage cheaper options.
But we were at the hospital and in the ER by the time you would have been to the office. And you have traffic too, even with your driver’s sirens—both to the office, and then again to the ER.
10
Good job Doc! Thanks for going above and beyond to consider the best course of action for your patient. I’m sure the parents are grateful to you for saving them a lot of money and reducing the emotional trauma to their child, not to mention taking time out of your schedule to personally see to his welfare in the car.
2
This article is irresponsible. I am analyzing two and a half years of ambulance run data for a large building where jackhammering occurred over a six month period. I am comparing months without to months with jackhammering. Most calls were for conditions like heart attack, stroke, major injury, difficulty breathing and mental health problems -- all conditions require professional EMS attention. Do not encourage people to call Uber or Lyft. Lives could be lost.
9
@Rodrick Wallace But keep in mind valuable time can be lost arguing with despatchers in Manhattan who want a lot of details before they will agree to send an ambulance. I went through this once with my late mother. When I recently had a late night accident (open, fractured, bleeding thumb) the first thing I thought of was to get a yellow cab, as I knew I wasn't that far from fainting and I knew I needed to get to ER quickly, which likely wasn't going to happen with ambulance.
I agree that if someone has stopped breathing or is clearly having a stroke or has been shot in head, you need to call ambulance, but for lesser stuff, like my broken bleeding bone, you maybe better off just taking a cab.
4
the problem is that emergency room staff take you more seriously if you arrive by ambulance.
9
If you’re not sure. Take an ambulance. But it will cost you 1000$ at least. And not covered by most insurance. Uber-30$ tops
4
Ambulances companies in Los Angeles are usually all private and the exorbitant charges are not reimbursed by insurance companies. Medi-Cal and Medicare covers the cost. So if you are not poor or old in LA, and it’s not an emergency, have a friend or Uber drive you. It was $2500 for 1/2 mile ride when my teenager fell and momentarily lost consciousness. Add that to the cat scan and MRI. Ugh.
1
For some, the financial setback of an ambulance trip can be immense.
And a helicopter life flight is even worse. we need Uber Heli Services! Yeah, fat chance there!
5
The US is a savage country run by the rich, big corporations, and big pharma. Vote Democratic if you want change. Doing anything else is a waste of time.
31
My husband and I were forced to pay for an ambulance to transport our teenage daughter from one hospital to another. We weren't allowed to drive her ourselves (never mind call an Uber!) Bill was more than $3,000. Same thing happened when she had a panic attack at college. Even after she'd calmed down, the college insisted she go by ambulance to hospital 5 minutes away and I was not allowed to drive her. My husband was an EMT for many years. We know they don't get paid squat. But I bet those CEOs are sitting pretty!
19
@ams
I'd like to see a college official or even a hospital official try to stop me from taking my teenage child off their premises.
1
@ams
You were not “allowed” to drive her? Were they holding her hostage? What you mean is that when they said firmly: “We have to transport her, it is policy”— you agreed. I assure you that if you had stood up and walked away, no one would have restrained you.
1
In small towns and rural areas, there are no taxis or Uber or Lyft and no vehicles accommodating the wheel-chair bound. Often there is no choice but to call an ambulance and pay exorbitant fees for trips. Guess there should be alternatives.
3
As an occasional Lyft driver, I have given two rides to acutely ill passengers. One was a concussed bicycle messenger in Chicago who had just had just crossed paths with a taxi. He was bleeding from a head wound, and as I drove him to the emergency room, I was concerned that he might lose consciousness.
Another young woman was in the throes of apparent appendicitis. She had requested a ¨shared¨ ride in order to save money. She was doubled up in the back seat, and apologizing to her father, on whose insurance she was, for the impending cost of the emergency room visit. Another passenger was added to the queue; fortunately, this new passenger was right along the route, and his pickup and drop off only added a minute or two to her suffering.
Two things strike me from these rides: First, ride share drivers are paid very little, sometimes earning less than minimum wage; asking them to take on the responsibility to care for, even for a short time, an acutely ill person is asking an awful lot. Second, the economic fear that impels a sick person to call a ride share when they are so ill is an indictment of our current system. A just system would not foist economic terror onto the pain of injury or illness. We need universal health care, including ambulances, for all.
And ¨all¨ includes the ride share drivers, as well as the passengers.
74
@Carlos Fiancé You should be in Congress!
You are many times smarter than my wretched Rep. Paul Gosar (Republican, of course).
8
@Carlos Fiancé, In a perfect world, everyone would live in harmony and everything would be paid for. But such is not our world. You should realize that the "universal health care" that you have so wanted would also be paid for in part by your less-than-minimum-wage income too, so matter how little it is. I know it sounds harsh, but one way or the other, the money has to come from somewhere. It's nice to have it paid for, as long as it's not by you, right?
1
Last summer, the ER doctor treated my husband’s wound to his finger but did not have the right scissors for the final stage of the treatment. He suggested we take an ambulance 45 minutes to the nearest hospital that had the equipment. The wound was covered and not bleeding. I had a car and was accompanied by a PA. The doctor did not recommend driving so the scissors was brought (by ambulance?) to the original ER. He seemed embarrassed by the whole affair.
4
The fact an ambulance is "billed at" (notice the language difference as compared to "costs") thousands of dollars is indicative of a different problem. Namely this is a service that we've tried to privatize even though it has all the traits that make this a horrible option for privatization.
Namely
- It's difficult to ensure competition. (Sick people don't have the luxury of dialing around to compare).
- It has a captive audience. (Sick people don't get to choose to be unsick).
- And it's mandated that the service be paid. (Neither the government nor insurance can just not pay for ambulances).
The end result is consumers are forced to use a service for which they are billed at the maximum value that the provider can possibly get away with before threat of regulation appears.
28
@Andy, your proposition of "ensure competition" is a loaded question. Your underlying assumption is, all ambulance service is the same and is paid for in the same way, yet that's hardly the case. For starters, it's different for someone who has insurance coverage versus someone who hasn't. If you do have coverage, then it's not decided by you but by your insurers. If you don't have coverage, then yes you should be able to do some kind magic push-button solution to find the "cheapest" (ideally) ambulance to ferry you to ER. But given that ambulance service is not used extensively, it's not likely that "market force" or any "competition" will drive the price down, because every single ambulance service knows full well that you're in dire needs when you call them. (I wouldn't do it cheaply for you if I know that my competitors will charge you king's ransom.) All in all, you will still end up paying dearly for calling an ambulance. Not that it's ideal, but let's have commonsense dictate it that ambulance really should be reserved for genuine emergencies, rather than non-life threatening incidents like a sprained ankle.
1
My aged mother lives in an assisted living facility literally across the street from a major hospital. Every time there is a minor incident (a slip and fall, unexplained pain, etc.) the assisted living facility "out of an abundance of caution" calls an ambulance to transport her the several hundred yards across the street. Once the ER checks her out, another ambulance is called to fetch her back home. Total cost to the taxpayers, several thousand dollars. She really has no need of the extensive medical equipment and expertise on the ambulance, it is just a (very brief) ride to the hospital. But the assisted living place is unwilling to take a risk in transporting her themselves on one of their wheelchair accessible vans. Crazy waste of money. Finally we convinced them to check with us before making the trek to the ER, and to save it for real emergencies. But clearly there is a market niche for rapid, uber-style transport that is wheelchair accessible and where drivers are trained in helping riders with mobility issues. Think of the money this could save the health system
15
Ambulance services here are part of the National health service that covers everyone cradle to grave at a fraction of the cost of the fractured US healthcare system. Flat rate fee of $0 for ambulance users. There are ad campaigns encouraging people to think about whether they need an ambulance and ER visit or a trip to a walk in centre or primary care physician instead, that seems to work reasonably well to minimise unnecessary calls.
27
@Neill, You can't really compare the universal coverage system in UK with the mostly private systems in US (except with medicare and medicaid). It's like comparing apples with oranges.
1
OK, so explain to me why, when my 83-year old mother who had dementia, difficulty walking and poor balance) was discharged from the hospital post leg surgery, was denied an ambulance to convey her to the rehabilitation facility. And we'd just had an ice storm...
It wasn't until I put it to the social worker in no uncertain terms which involvedthe threat of lawsuits being filed, we got an ambulance.
The social worker's plan was that we use my niece's handicap accessible van to transport my mother. Right - that vehicle had been modified for my niece's wheelchair - not a woman on a stretcher. And my niece was supposed to ride where while we transported Mom? The SW's next suggestion was that i exchange my rental car for an SUV (preferably a suburban) so that my Mother could be levered, stretcher and all, into the back.
To this day I can not figure out what the issue really was, though comments were made about "overconcerned daughters who did not understand healthcare costs".
In the end we did save the health care system considerable costs as my mother was so upset by the delay in her discharge tht she resed to ever again set foot in a hospital.
9
@elise, I totally hear ya, but my question is this: Is ambulance service for emergency services only? If yes, then the social worker was right to help you figure out alternatives to transport your mother, whose conditions (senior, dementia, just checked out from hospital with leg injury) are not necessarily one would call "emergency". If you can find a wheelchair accessible transport for her, why is it a worse option, in your opinion?? And, if you have to pay from your own pocket a couple of thousand dollars to cover for the true costs of using that ambulance to ferry your mother back home, would you still insist on it? (I highly doubt it.)
1
Ambulances can be such a scam. My wife and son (in a stroller) were hit by a car in 2015. Son was fine, needed no care. Wife had hairline fracture in her tibia, could walk w a limp. Someone called an ambulance which took them half a mile to our local hospital. No emergency treatment en route at all.
Bill for wife— $1,754. For son— $3,400, because he had to be strapped into a car seat. They were in the same vehicle.
Do I want good care for my family? Yes, at all times. But we can all be more practical about unnecessary costs at the same time. If the driver’s insurance hadn’t been liable for the costs, we don’t know how we would have paid that, and for what, really?
27
@Matt Your wife could have refused transport. Anyone who is conscious, alert, and oriented can refuse to go with the ambulance.
4
@Molly Yes, in a city like Boston or New York you can just get a cab.
So, the patient (who is NOT a medical professional) is supposed to diagnose himself and determine whether or not there is a medical emergency?
28
@Apowell232
Yes, the Capitalist model. Fend for yourself. Or get rich through tax fraud like Trump and buy private doctors to take care of you whenever wherever. The other option is to vote for a progressive Democrat who will push for universal health care, like in almost all other Western countries. The US is all about the money.
14
@Apowell232
Yes, people can make some basic decisions about their own health. If you spend an afternoon in the ER (I did recently, for a school project) you will see many people in with minor complaints (sore throat, rash). If you asked them: “Do you think this is a life-threatening emergency?” they would certainly be able to tell you No. They are just in the ER because it is convenient; their doctor doesn’t have any open appointments; they don’t have transportation to anywhere else; etc.
1
Recently, at 10PM, I suffered a hemorrhage after major cancer surgery at MSK. I was afraid of bleeding out. I hailed a taxi outside my apt building and got up from the West Village to Sloan Kettering in 12 minutes !
I believe the taxi driver understood NYC better than most Uber/Lyft/Juno drivers who rely on Google or Waze.
It never occurred to me to seek an ambulance since I needed fast service.
For some people however the cost of a private car or taxi is daunting. Alas- often ambulance charges fall on the patient anyway!
17
@Sara I had a similar experience when I had a late-night accident that resulted in a bleeding unstable fracture. I hailed a yellow cab to take me to the NYU ER, got there in less than 10 mins for about $10 (was midnight Sunday on a holiday weekend) and had surgery the next morning. Like you, I did not want to waste time calling for an ambulance, discussing my need with a despatcher, then waiting for the ambulance to arrive. The funny thing was when we got to NYU I expected the taxi driver to drive right up to entrance to ER, but he left me off in middle of First Av. as entrance to ER and parking lanes blocked by unused ambulances (guess was slow night).
1
also, just take me to a pharmacy. I hate hospitals.......
1
around here, get injured in a car crash and they helivac you to the next county as the local hospital doesn't have a trauma center... you think ambulance rides are expensive, you should see what a helicopter ride costs.
21
For the past 45+ years, we have lived where the only ambulances are the volunteer rural fire department and you only called on one only in extremis. If you do use it, the cost is usually a couple of hundred dollars for a 40 mile trip. Almost everyone donates as much as they can during the annual fund raisers. All other cases you drove yourself or the neighbor took you. There are no cabs, Uber or Lyft services. Even now, it is known throughout the community if you go to the local hospital for something like a heart attack, you might as well keep driving to the nearest big city hospital 2.5 hours away because the local hospital will send you there by ambulance anyways as soon as you are stable. That is rural health care in much of the US today.
23
Tom is right about the state of emergency transport in rural areas. Many in our area buy a yearly membership in a helicopter ambulance service because if you are in a major car accident, have a heart attack, etc., you are going to be referred out, meaning at least 50 miles and maybe 250 miles. If you are a rural resident you’d better be self sufficient and have low expectations for surviving a heart attack. It’s one of the trade-offs for living in the country.
4
We have a cottage in Northeast Maine. Same thing here. I spend my summers hoping I don’t have a major medical emergency
1
I hope that readers now planning on taking an Uber or Lyft or other rideshares to the emergency room are also reading the current article here in the Times about how to tip Uber and Lyft appropriately. These drivers are not getting rich, and just as much, love the show of appreciation.
13
Ambuletence use runs rampant among elderly residents of assisted living, and non medical retirement communities. When elders take falls (which happens frequently) they're required to get evaluated, and these facilities aren't equipped to do it. No xrays, and no skilled professionals on site. Medicare feeds the profits of the hospitality and amulence industries, and the inefficiencies burden us all.
14
Rideshare drivers are not trained, equipped, insured, or adequately compensated to be responsible for someone with an emergency medical situation. Some drivers will probably refuse. This is not good advice. We need more information on who is using the ambulances and why.
33
@John in nyc the FDNY starts its EMTs just over 15 hr. Paramedics start a little over 20. At city meetings the salaries cited include estimates of forced overtime and department averages. I agree with you entirely except for the 'adequately compensated' part. There are FDNY EMS captains working as TCs as we speak.
This is the same sort of discussion as people going to an emergency room with a sore throat, instead of going to a walk-in clinic (if you don't have a primary care doctor, or it is off-hours).
The waste in the health care system from incorrect usage is staggering.
30
@A Mann It's funny -- when I visit my family in the Phoenix area, I see 24-hour urgent care facilities all over the place, very well-marked. But in Boston, where I live, I haven't the faintest idea where I might find one.
9
@A Mann: Both you comment and Jon's suggest an interesting question: Why isn't there a 24-hour urgent care facility at the hospital? I'm guessing it's because then they couldn't charge you $5000/hr to wait in the waiting room. But, I'm a little cynical.
3
Ambulances signal emergencies; go by car and take your chances: I felt an unexplained dizziness 3 years ago and finally had my wife drive me to the emergency room at the small, but busy, hospital in Hilton Head.
I wasn’t “an apparent emergency” so I waited 3 hours for someone to look at me. It turned out to be a stroke. I spent the next 9 weeks in a rehab hospital in Savannah. I’m still limping from the aftereffects.
This year, in Pennsylvania, I felt a similar dizziness, with tingling fingertips and breaking out in sweat. An ambulance got me to the emergency room at Hershey Medical Center where a young D.O. diagnosed the onset of a stroke immediately. They gave me a TPA shot and three days later walked out of the hospital, none the worse for wear. You get immediate attention when you arrive in an ambulance. Don’t pinch pennies.
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@Robert The hospital in Hilton Head had an incompetent nurse in triage: Chest pain; shortness of breath; dizziness, lightheadedness or other possibly neurological symptoms; sudden headache; sudden nausea/vomiting... these and several other presenting symptoms should get an immediate medical exam.
19
@Robert Spent 15 years as a Paramedic; arriving by ambulance is no guarantee that you'll be seen any faster. We triage you, and can just as well send you to the waiting room as to a treatment room. It sounds like you were improperly triaged by the ER.
20
@Robert An ambulance is no guarantee. Last year, I fell and broke a leg. I called an ambulance (since I couldn't even get up, much less get into a car!).
They took me to the local ER, where I was triaged and put in a wheelchair... and left to sit in the waiting room for 90 minutes before I was seen by a doctor.
3
Perhaps the co-pay for ambulance use should be high enough to discourage unnecessary use? Another approach is to evaluate AFTER THE FACT the medical emergency. In short, if you take an ambulance because you are in serious medical danger, then it is covered. But if you are doing so for conditions that are not life threatening, your copay should be higher. The ambulance service would have to tell the requestor how costs are determined. Yes, I know, people in actual medical emergencies could be delayed, but the ambulance could be dispatched immediately while the operator explains the charge structure. If the ambulance returns, no charge? My point is that sometimes refinements are required. Good intentions can be abused, hence the need to go back and fix issues.
3
@Bruce Maier
Co-pays are one of the worst ideas in medicine. People use less inappropriate care, but they also use less appropriate care. The effect is stronger on the poor.
Do you want to be in the position of having chest pains, not knowing whether it was a heart attack, and having to decide whether (1) It's not a heart attack, and $1,000 or more for an ambulance would be wasted; or (2) It is a heart attack, and saving $1,000 would cost you your life?
Frakt had a column about this, in which he cited the peer-reviewed studies on co-pays, including the classic Rand Health Insurance Experiment. https://www.nytimes.com/2018/07/30/upshot/shopping-for-health-care-simpl...
One other study in the New England Journal of Medicine found that in one population of elderly women in Medicare managed care, imposing a fee of about $15 reduced mammograms by about 10%. The effect was strongest in the poor.
22
@Bruce Maier I have great insurance, but my one ride in an ambulance still cost me about $800, on top of what my insurance paid. Lack of copays is not the problem here.
12
@Bruce Maier The problem is that we allow private interests to swoop in and extract the most costs possible from the system. This happens all over healthcare, not just ambulances. Punishing the patient isn't the solution. The system is already stacked against them. People avoid going to the doctor, cut their pills in half, put off surgeries, and more because of exorbitant costs.
13
Just as a note: I've had two ambulance rides, both of which happened because bystanders saw me have an accident and called 911. It isn't always under the patient's control.
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@Charlesbalpha
Paramedics can’t make you get in the ambulance. You can decline.
6
@Charlesbalpha
You can always refuse an ambulance. (I’m not saying you should have; I have no idea what happened to you!) I’m just saying that yes, it is always in the patient’s control, as long as they are conscious.
2
In Pittsburgh, ambulances are FREE. You never get a bill.
They do bill your insurance (if you have it), and accept whatever your policy allows, but you never have to pay any balance.
31
This must be a city run service. Those rides not covered by insurance don’t disappear...you’ll see them in your city tax bill.
8
This article does not mention another cost of ambulances: the devastating cost itself. I would be interested in what proportion of the 30% unnecessary ambulance rides insurance does not cover, because the cost is absolutely devastating.
My sister's husband had a panic attack in 2012, before Uber / Lyft were around. They were worried it was a heart attack. They had just moved to the US and could only find one cab company, which was busy. So they took the ambulance.
The cost of that ambulance ride was $4000. They could barely even afford the plane tickets to move here from Australia. I don't recall if ambulance rides were not in their health plan or insurance decided not to cover it.
We are all fortunate to have more options but the exorbitant costs continue to be excruciating, and I suspect life-destroying to some people.
16
@MST
I agree. I have had two experiences with ambulances, and one involved outright fraud (claiming an unconscious patient gave consent to the use of the ambulance) and the other wrongfully advised me it was covered when I was reluctant to use an ambulance when a car ride probably would have sufficed. Both ended up with huge fights regarding payment.
I prefer real taxis to Uber or Lyft, but this is a case where these services make huge sense.
9
@MST Your first mistake was leaving a country that has universal healthcare coverage. Your second mistake was moving to the United States.
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@White Buffalo
If you're unconscious, then, legally, consent to medical treatment is implied. The law presumes that anyone who is unconscious would, if conscious, agree to care that, since they are unconscious, could be lifesaving.
Think about it.
1
Living in a rural area there is absolutely nothing of a uber or lyft. We relied on our local volunteer ambulance service. The suggested donation was $25.00 for the year. To get to Doctor's apppointments, another service here is the county transportation van for the handicapped and elderly. This another suggestion for those who live in parts of the country that does not have uber or lyft.
17
A year ago I was home alone without a car (in Minneapolis) and experienced pressure in my chest. I knew from experience that Uber/Lyft often get to my house in the city within a minute or two. I punched in Uber and sure enough a driver pulled up a minute later, and the address of the nearest ER was already on his phone. I told him 'If he could hurry that would be great'. We got to the ER in ten minutes. Sure enough, I was having a heart attack and they rushed me into the operating room. While being rolled into surgery the doctor asked how I got to the hospital and I told him in an Uber. "Well, that's a first!" he laughed. I don't know how long it would have taken an ambulance to get to my house, but it surely would have been more than a minute. Had I died in the Uber, this story might have a different moral, but I'm alive, doing fine, and it cost me about $15, not $2500 or whatever crazy charge the ambulance would have come up with. With a heart attack, it's all about how fast you get to medical help, so all I can say is it worked out for me...
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@jkat Very glad it worked out for you. I know ambulances are not always right at hand. It makes me sick to watch ambulances struggle through NYC traffic. But I know of a man whose wife got him to the ER waiting room, where he died of a heart attack. We friends and family learned from that episode that an ambulance ride gets you past the waiting room directly to the hands-on staff in the ER. Realistically, jkat, you could have died in the Uber.
Seriously, everyone, ambulances are certainly not always necessary, but when you think you are having a heart attack, they are. If the time it takes for one to get to YOU is less than the time it takes for you to try to drive/ride to the ER, call the ambulance.
1
@Maria
ems will diagnosis and treat prehospital. you only go right in if they have diagnosed you as needing to do so. then they will activate the appropriate medical team to wait for the ambulance. the point is medical care occurs when the ambulance reaches You, not the hospital.
The article doesn't address the important issue of how a lay person can determine whether something is urgent enough to require an ambulance ride or if it is mild enough to wait and be seen in an urgent care clinic or by their own doctor a few hours later or even the next day.
Some healthcare systems linked to insurance have 24 hour hotlines patients can call anytime to speak to a nurse or other clinicians to gauge how urgently they need to be seen or whether it can wait, might be solvable with something at the drug store. Without such assurances, using Uber or Lyft might lead to deaths and complications due to delayed care.
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@ms Correct - but even medical professionals are mostly guessing when they can neither view the patient or perform the necessary tests. Clearly, you have to use common sense, which we all know is less common than assumed.
9
I agree that there's no intrinsic magic to Uber or Lyft; any non-medical transportation service can be appropriate when medical attention en route is not an issue.
But my real gripe is with the interpretation of the finding that ambulance use went up with ACA. This is typical, I have to say, of the bias of most economists, that everyone is out to chisel if they can -- the fixation on incentives. It's certainly true that some people may take unnecessary ambulance rides if they don't think they have to pay for them, but it's also true that many people *don't* take rides they should because of financial constraints. Without more data we have no basis for saying how much of the difference in use is due to the first versus the second. (This is also a huge issue in disability/work research.) Still, the author of this piece has no problem attributing it all to overuse post rather than underuse pre. This is not evidence-based analysis.
41
@Peter Understand you don't like the statistics that demonstrate that ER use has not gone down with the ACA and ambulance rides have gone up with the ACA. But, those are the facts and cannot be disputed. Data doesn't have a political leaning.
3
I have a chronic condition which requires hospitalization at least once a year. Before I go anywhere, I have to wait until the main symptom, copious vomiting, subsides and then find a way to get to the ER, 6 blocks away, before it begins again. I have bad knee, which makes it difficult for me to get into cars, so I usually try to take a bus. If they are not running, I call a cab and have to request an SUV, as this is easier for me to get into and out of. The last time I had this condition, I was too weak to get myself out the door and contemplated calling an ambulance. I just couldn't do it, so I toughed it out at home. It worked out all right this time, bit I shouldn't have done it. I have seen the way Uber and Lyft drivers fun red lights, make illegal turns. I wouldn't want to entrust my life to them.
3
One problem is that unless you come by ambulance, the ER personnel don't take you seriously. That results in a long and sometimes painful wait. And no they don't respond to requests for immediate service.
60
"The high cost of an ambulance isn’t really for the ride. It comes with emergency medical staff and equipment".
I would love to see an itemized bill that explains how this can legitimately add up to thousands of dollars per ride. Even if the EMTs or paramedics were paid $100/hour (which they aren't, from what I've read), a typical ambulance ride would total less than $100 in personnel costs. The equipment, if the ride was unnecessary, will probably be largely unused, but I suppose one has to pay for the "rent" of capital equipment. Is that it?
40
@Bob The equipment part is a big chunk of it; buying and maintaining high-grade medical equipment is very expensive. Insurance is also a huge factor. Accidents do happen, and the companies need to be covered financially when someone's family tries to sue for millions of dollars.
As for EMT and paramedic pay - EMTs are around $15-20/hr, paramedics up to around $50/hr from my experience. Personnel costs are not a large percentage of the bill.
2
@Chris
my god, where are paramedics getting 50? I get 22 and change and I'm top pay. Of course, overtime is time and a half, but I'd rather go home after 16 hrs.
They pay EMS nothing in nyc.
This article someday perhaps will have saved my life. For now, it's saved my peace of mind. Living where I do, I've been terrified that, when I call for an ambulance, they'll insist of Bronx-Lebanon and refuse to take me to Maimonides, which is further north. This solves my dilemma — unless I'm on death's door, and even then I'll probably have to think which service to take.
21
@HKGuy I have been in two NYFD ambulances in the last four years. Both times they asked me which hospital I wanted to go to.
I have no idea if that's common. I had a colleague in heavy labor at our office and they would only take her to the nearest hospital. But that may have been because of how advanced her labor was. (third child)
6
@HKGuy
Last I knew Maimonides was about 12 miles southeast of Hell's Kitchen and two boros away from Bronx-Lebanon.
What about the hospitals in Manhattan?
2
@Peggy. Yes. The one time I was in a NYFD ambulance they asked me where I wanted to go. As it happened, I was in the park near me and the closest hospital was the one near me that has all my medical records.
One strange thing is they took a circuitous route to the hospital. I was left wondering if they made more based on the mileage. .... I pulled out my bill. I surmised correctly. They billed $704 for the ride plus $24 for mileage. Medicare approved $412.95 and $14.48. I paid $82.59 + $2.90.
As others have noted you get more immediate attention if you show up in an ambulance.
Just another illustration of how sick our health care system is. If you are having what you believe to be an emergency - you must now - make sure you go to an "in-network" ER, then make sure everyone who touches you or provides a related service at the ER is "in-network" and then analyze whether your emergency is cab-worthy. In the meantime - hope you don't die from the emergency. It's just beyond twisted. Still waiting for Trump to unveil his wonderful healthcare system that will cost me less and deliver better service.
101
@Dana. My in-network ER required me to sign a paper saying that I agree to pay the costs of out-of-network treatment before they would treat me for what I thought at the time was a heart attack. Thankfully, it was not a heart attack; that may change when I get the bill.
15
I was once told by a doctor to always call an ambulance for a seizure. A friend in college had a seizure disorder and her doctor gave half a dozen of her friends "Seizure 101" as bystander training. We were told never to take her to the hospital in a private vehicle because "no untrained driver can focus on the road when someone is having a seizure in the backseat."
So calling Uber, Lyft, or a taxi would make a lot of sense when the patient is stable; conscious, rational, and quiet; and not bleeding, vomiting, urinating, or defecating uncontrollably. But let's no confound medical treatment by adding car accidents on the way to the hospital!
32
@Adina
if you are having a true grand mal seizure then you are not breathing adequately while the seizure lasts. The ambulance has medications to stop the seizure activity so that the patient can breath. The patient can start breathing seconds after the ambulance arrives. Or the patient in a private vehicle goes all the way to hospital without adequate air.
4 years ago I could not sleep and had the elephant on my chest. I checked my blood pressure at 5:30 am, it was sky high. I carefully got dressed. No shower. I didn't want the closest ER. I ordered UBER.
The car came immediately, traffic was still low and night tragedies were mostly over. I concentrated on breathing calmly. 15 minutes later I was at my preferred ER. I walked in and said chest pain. Instant attention.
The same Dr that had done an angiogram to me 20 years prior and told me to wait for better stents, installed the latest. We recognized each other.
I think stents last 7 years. 3 to go.
and I now live rural with no UBER.
Thanks, Dr Benzuly!
35
This has been a pet peeve of mine for almost 30 years. I'd say 85% of the calls I have responded to in my career as a paramedic/firefighter have been unnecessary. Most people call because they are frightened and/or don't know who to call in certain circumstances. Others think "my insurance will cover it" (surprise! they don't want to pay for unneeded ambulance rides either). Some people, in police custody, say the magic words "chest pain" and have a get-outta-jail-free card, as cities will cite and release a suspect so they aren't responsible for the ambulance/hospital bills and the "pt" has no insurance and no intention of paying the bill anyway. By and large people have just gotten used to a quick response when they dial 911 and being afraid of the litigious consequences of talking someone out of an ambulance ride we just take you. It's less paperwork and sometimes I must contact a base MD for permission NOT to take you. The MD sometimes wants to talk the pt into going as well. It ties up resources and you can hear other calls waiting while you're dithering on the phone with the base doc over strep throat or a minor infection already treated three days ago in some other ER (why do people think going to a different ER is going to make a difference?). If people were logical they'd realize it's a limited resource and, therefore, expensive. The more people abuse it the less the system works. I've been saying this for 30 years and no one would listen. Maybe now is the time.
68
@William Dennehy EMTs are the best. But going to a different ER really can make a difference. The one closest to my house was so awful the first time I had an emergency (they billed for tests I didn't take, listed my medications incorrectly, and it was dirty) that the next time, I insisted the ambulance take me somewhere else.
And I think people call 911 because that is what we are taught to do in an emergency.
21
@Jennifer I agree with both you and William. We have done such a good job of pushing 911 that we now have to work with the unintended consequences. In my career call volumes have never gone down one year to the next. I trust that in the future we can develop recognition of when to call and how to use Emergency Medical Systems (EMS).
As far as taking you to your choice of hospital, we cannot kidnap you, but sometimes in your best interest we must follow protocol and take you to the nearest APPROPRIATE facility.
@William Dennehy If insurance does cover it, you can bet that the price will be inflated to a "Donald Trump black-car" level price. Ever been in the hospital? Look at the bill sent to the insurer: Ryker's Island cuisine at Per Se prices. People conveniently forget that, ultimately, we all are paying for these inflated fees.
7
What concerns me about this article is the fact that the poor are not addressed in the ridesharing economy. If a child needs to go to the hospital and mom doesn't have a car or a credit card, she certainly isn't hailing an Uber/Lyft. An ambulance may bill her at the end, but they won't get paid. Ridesharing simply doesn't work in this situation.
47
@Torie Tokui
Perhaps hospitals and urgent care offices could provide Uber/Lyft calls for patients who didn't need fast medical attention? I'm thinking about my kid's broken wrist a few years ago, it needed treatment immediately but wasn't life-threatening. My husband drove him to the orthopedic urgent care, but for someone who didn't have a car or the ability to contact a rideshare having the urgent care able to get one for them would be great.
12
@Jennie Hospitals in my region are working on incorporating the ridesharing option as a solution. It would really help to reduce demand on expensive ambulances. However, taxi drivers have stated they'll refuse patient ride vouchers hospitals provide if the hospitals (we have joint hospital-insurance companies here) also use ridesharing companies. Lose-lose situation.
1
Answer: vote Democratic and tell all your friends to vote.
2
We needed an ambulance to transport a family member from Columbia-Presbyterian to a facility in Katonah, NY, and it was an expensive bill which we had to pay. Sounds like this would have saved us over 100 dollars.
7
If you get to the ER under your own steam, as I did at a local Level One trauma center with a ruptured appendix, you may well not get the same immediate attention and concern which you receive when arriving by $2,000 ambulance ride. Through the front door, first you have to deal with security, metal detector, pat down and paperwork, a little challenging to comply with when you are writhing on the floor in excruciating pain. Probably the best way to get noticed is by helicoptering in, at vastly greater cost. A real hole in how the system fits together.
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@Don Cook
About a month ago, I took a cab to the nearest hospital with chest and jaw pain, shortness of breath, profuse sweating, and nausea. I waited patiently behind the person ahead of me at the front window and when it was my turn, I told the clerk my symptoms, she snapped a bracelet on my wrist and told me to have a seat! I felt so lousy, I couldn't deal with a confrontation.
I sat for at least 15 minutes until a nurse came out to get yet another patient and I told her what was going on. I was called right away. It wasn't a heart attack, but I was admitted for 3 days and finally the doctors determined that the calcium channel blocker I've been taking for about 4 years to control my coronary artery spams had stopped working. The dosage had been lowered after I had a stroke and if they tried to raise it. my blood pressure tanked. I saw my cardiologist right after discharge and she prescribed another medication which solved the problem.
But what if I'd been having a heart attack?
18
@Don Cook
Security?
Metal detector?
Pat down?
Paperwork?
Oh the joys of living in a Country with Free Universal Health Care and no gun culture where an ambulance or trip to an Emergency Dept or Hospital gets you almost immediate attention , treatment and care.
Free.
21
@Don Cook While this may true to a certain extent, it should be noted that any patients with non-life threatening conditions who get picked up by an ambulance will still be sent to triage when they arrive at the hospital. It is not a free pass to the front of the line, unless the condition warrants that.
2
Like with anything else in life, whether it be motherhood, apple pie or ambulances, they can be abused.
There is a local alcoholic in my area who lives in the street, who over the past 15 yrs. must have been picked up by an ambulance at least hundreds of times and let out usually the next day instead of being put in a secure home to protect herself.
5
Ok. You could also call a cab
38
@Rhporter Cabs don't operate everywhere, especially in less-populated areas. And even where they do, they are sometimes unreliable. Not everyone lives in a city where you can flag a cab on the street corner, or where a cab will actually show up when you call.
7
In some places cabs won't transport people to the ER due to liability concerns. I'm not sure Uber and Lyft should do it either, for the same reason. It's one thing to get there under your own steam (walk, bke, own car with someone else driving, public transit) where no one is responsible for your condition upon arrival but you. Using a cab/Uber/Lyft puts a certain amount of liability on them, especially if you have no one else accompanying you. The ambulance, while expensive, is equipped to handle anything that might come up during the transport.
3
@Joe
You are correct to be concerned about the liability issues. Uber and Lyft drivers could possibly be held liable for problems (like the death of the patient in their car!) that arise while the sick person is a passengers. No auto insurance company is going to cover that type of liability. These people are not equipped to transport sick or injured people to emergency departments or trauma centers.
Moreover, although cost is always an issue when it comes to healthcare, when one’s life is at stake getting to the hospital via a fully equipped ambulance or EMT is primary.
In another situation, outpatient surgical centers here in Los Angeles will not allow a patient to be transported home by Uber, Lyft, or taxi. Liability is cited as the risk.
2
Ambulances are another example where the "free" market fails us. We could easily provide public ambulances at reasonable cost. So here's an idea: let's do it. And then someone suffering chest pains won't have to worry about calling Uber or not just so they can save money, when it turns out they might actually need blood thinning medication before they get to the hospital.
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@John Krumm
Our local ambulance system is a public service and they still ask for six hundred for a transport, though they do have a mechanism for forgiveness if you can't afford it. I vote for their levies regularly because I appreciate them and agree that they shouldn't be profit-oriented companies. I do think they could maybe use a method to transport patients with less life-threatening but urgent needs though.
15
@John Krumm "We could easily provide public ambulances at reasonable cost." There's your stumbling right there. Why believe this??
3
@John Krumm Actually, John, that's not true. There was a time when there were public ambulance services, but it failed as the cost is astronomical. The main issue shouldn't surprise you - people use the ambulance without any care as to whether they need it. And you cannot staff an ambulance with the assumption that the person calling you doesn't need anything - like oxygen, defibrillators, medical personnel, etc. An ambulance is like a small ER, and when you don't need it, you waste many valuable resources. But, some don't know how to decide whether they need it and given the litigious nature of the US, the ambulance company cannot make a mistake. So, staffed for the worst case even if only needed 5% of the time.
3