You might see prop vehicles and such but they tend to get run to death then auctioned off to the public as vans with cabinetry and kick ass electrical systems. You will see cash strapped areas buying used equipment, but in general you dont want to bet patients lives on equipment someone else has discarded as not useful, its not worth the liability.
They could be quite useful as prop vehicles, though. The engine might not run well and half the medical gear in the back might not work, but then all they really need is to look 90% of normal while crashing into that brick wall. And much of the old medical equipment should be easily reusable as prop medical equipment. Clear!
Well, the NHS uses a computer assessment to triage (pdf) calls and will not send an ambulance if the program deems the call not to be an emergency (which produces an occasional false negative). And certainly there are plenty of kooks in the UK who call 999 for frivolous reasons.
You can’t really compute the cost of an ambulance ride simply by adding up the expenses, plus a little profit for the provider. It just doesn’t work that way any more (and hasn’t for almost everything for a long time).
Things involving selling & distributing commodities (gasoline, oranges, pork bellies etc.) are still more figured like that, but service industries just have too many variables (the cost, amortization, & maintenance of the vehicle, the price of gas, auto insurance, the medical equipment etc.) Point is this: What it comes down to is US ambulance companies charge the maximum amount that they know insurance companies are willing to reimburse them, whatever that is and however *they *compute it. Actually they’ll charge more than that because they know they’ll only ever get paid at most 50, 70, 80% of it.
This is a HUGE pet peeve of mine. The transport distance has little bearing on the amount of service. This week I had a patient that I transported less than 2 miles to the hospital. He was having a severe allergic reaction. Before we got to the hospital, he’d gotten oxygen, intramuscular epinephrine, an IV, IV fluids, IV benadryl, IV methylprednisolone, and IV ondansetron. He also had cardiac monitoring and pulse oximetry. During this time he also had either 2:1 (on scene) or 1:1 (during transport) care from paramedics. During the same shift, I also transported a patient about 18 miles to the hospital. That patient had an assessment and a couple vital signs checks.
An ambulance that you’d actually want to spend a whole shift in/treat a patient in is much more expensive. these cost around $110,000 without any medical equipment. Amongst other things, you’ll need a 12-lead monitor-defibrillator with pacing and end-tidal CO2 monitoring (at a minimum). Our monitors cost roughly $35,000. You’ll need one in every ambulance and a few spares. There’s annual service costs to go with that, too.
Ambulance life spans vary greatly. Our ambulances probably run 3,000+ calls a year. They typically last 5 years, or so. There’s a significant amount of idle time on the engine that’s not reflected in the mileage. An ambulance that runs 911 calls is going to have a lot of heavy use- hard starts and stops that introduce additional wear as well.
When they retire, the box will be remounted on a new chassis, which saves money over buying a completely new ambulance.
I’m pretty happy with my pay, but at the same time it’s noticeably less than the police officers and firefighters that respond to the same calls I do. Off the top of my head, I don’t know of any service that employs anyone just as an “ambulance driver.” In most places EMT is the bare minimum to get an ambulance job. We staff 2 paramedics on our ambulances. There’s HUGE variations in pay depending on service type and location. In my opinion, the pay is generally too low and that creates other costs- frequent turnover and a lack of experienced providers.
I don’t have numbers on supplies or medications. That said, I’m sure they’re expensive on the ambulance for the same reason they’re expensive in the hospital.
Services that I’m familiar with had collection rates between 30% and 50%. In places I’m familiar with Medicare reimbursement for a 911 call was at best a break-even proposition and Medicaid was a money loser but better than nothing.
Amongst other factors, you’re also paying for staffing and administering a 24/7/365 911 medical response system.
I just got done with a night shift so I’m going to bed. I’m sure I’ll have more to add later.
St. Urho
Paramedic
In NYS the company i worked for chargerd 700 for a ride and 1200 for paramedics . I assumed its because the job is risky and stressful. You have to have counciling avaliabe for when people burn out. You also have to cover workers comp. There are also other various cost.
I wasn’t aware of the specifics of the system, but I’m aware that the calls are filtered. But if the NHS can do it, a similar service in the US can do it too.
Following my heart attack, my cardiologist wanted to transfer me to a hospital a few miles away for angioplasty. I initially wanted to drive so that my vehicle would be nearby for my eventual release, but the doctor convinced me otherwise.
I got involved in the decision making. The local ambulance company would have charged close to one thousand, and my insurance wouldn’t cover it. My insurance would cover, in full, my local ambulance company. So I waited an hour for an ambulance to drive 45 miles, load me, then drive me a few miles cross town.
Weird, but it worked. I asked the paramedic and he said, “insurance”.
Probably the best answer to the question in the thread title is that fee-for-service is a stupid way to fund emergency medical services. Most of the costs are fixed- staffing, vehicles/maintenance, training, administration, billing, and dispatch. 911 call-taking and station costs may be part of the equation as well depending on the system.
We also respond to a lot of calls for which we are not reimbursed. In my system, if we respond on someone who’s intoxicated and has no trauma or medical complaints they go to a detox facility. We are not reimbursed for responding or assessing that patient. Additionally, if that person is transported to the hospital, health insurance won’t pay for that transport which, in practical terms, means we won’t get paid for that transport.
If we respond on a patient who refuses transport we are not reimbursed, no matter how much time we spend with them or what assessments are done. Most services that I’m familiar with will bill for a “treat and release.” For example, a hypoglycemic diabetic who is treated with IV dextrose typically doesn’t need to be transported to the hospital. In practice, most insurance companies won’t pay these bills, so nothing is collected. Why the insurance companies won’t pay a minimal charge for the treatment but would pay for an ambulance transport and ED visit for the same condition is beyond me.
There’s a few private, interfacility only companies in my area that will buy used ambulances. It’s fun to play the “what ambulance did that used to be?” game, but I can’t imagine having to actually work in one of them. Our ambulances are maintained frequently, and by a company that ONLY does ambulance maintenance and you can still tell the difference in how they drive in the last 50-75,000 miles before they retire.
There used to be quite a few old ambulances converted to mobile homes around here, but I haven’t seen one for years. The NHS would sell off seven-year-old van based ambulances that had done a lot fewer miles than a similar van that had been used commercially. Private DIY’ers would buy them and do the conversion. Some were pretty good - most were not.
I don’t know what happens to them now - probably they go for scrap, or get converted back to vans. Our local Ambulance Trust has experimented with swap bodies - the idea is that the body, and the kit inside, will last a lot longer than the chassis and the engine. In practice, it proved not to be the case, as the interior needs to be updated with new tech all the time. I believe that they were top heavy as well, so prone to falling over when driven fast round roundabouts, of which we have many.
I know someone that was (unfortunately) airlifted 75 miles. The bill was $18000.
Mom and Dad got the bill in the mail but eventually, because it had been insisted upon by the physician, Hopkins picked up the bill.
Our ambulance boxes typically get remounted on new chassis 2 or 3 times before getting retired. There’s upgrades to the lighting and electronic systems that go with the remount, so it works for us. We also use a custom box that’s noticeably shorter than most other ambulance designs. Combined with a dually rear-end its impressively stable.
Air medical is a whole different ballgame. I think this article gives a good introduction.
There’s some controversy in the EMS community over whether or not helicopters are overused, also (I think they are). That said, I work in the city and we never utilize them.
When I worked as an emergency medical technician in the state of New York in the early 2000s, it cost nothing to make the call to warm up the helicopter.
The second the skids left the ground it cost $5000.
This was both with a volunteer ambulance corps connected to the town where I lived, and an ambulance company that paid me an hourly rate.
We never consider the cost. You call for a helicopter when you know that every second counts, and you need the person flown much faster than you can get some place in an ambulance.
This was a Orange County New York, a mostly rural area. Depending on where the helicopter was coming from, it still took a fair bit of time for them to reach you, load it up safely turn around and fly back to Westchester County Medical Center.
Depending on the case, we would load up and start driving to a pre determined meeting place with the helicopter.
If the situation was simply too fragile, we would stay put and try to maintain the patient until the helicopter arrived.
I only had to make a call for a helicopter once personally. I witnessed an automobile rollover on the New York State Thruway, pulled over, and responded to the scene. The severe nature of the trauma demanded a helicopter response.
The money simply does not enter into the equation at that moment.
The volunteer ambulance corps that I was just to see that with attempted to collect it through insurance on every call we did. We were not always successful.
It is important to mention that unlike all fire agencies, including hundred percent volunteer ones in rural areas, many EMS agencies get almost no money from the local municipality. This was the case in my town. Aside from fundraising campaigns that involved bulk mailing, all of the income and support of the entire ambulance corps came through insurance billing.
On the subject of air ambulance, the insurance company I work for will cover air ambulance back to the US, but only to the “nearest appropriate facility”. For Mexico and the Caribbean that’s generally El Paso, Miami, or San Diego. It happens from time to time that one of our subscribers will demand to be taken back to Minnesota. We’ll cut off the payment at any mileage beyond the nearest appropriate facility and they’ll wind up owing well into the five figures what would cost a couple of hundred on Southwest once they recovered.