With these expensive rides how can anyone wonder why insurance cost so much? It's not the high cost of insurance that is the problems, its the cost of getting a doctor, hospital, or EMT to provide services. Many times, even the insured, attempt to reduce costs even in emergencies. Every health care professional regards all injuries as critical until they have at very expensive ER's that you are not seriously hurt. There's a lot of overkill in medical services in a attempt to thwart off malpractice and its killing medical service costs. The only draw back for the injured trying to keep personal costs down is that it gives insurance companies and 'out' to deny medical coverage. So insured or not insured, the individuals are caught in the middle and health care is once again marginal and excessive in cost. Having insurance gives health care services and open book on what they charge for services, even minimal services. The phrase 'customary and reasonable charges' has lost its definition of reasonable. Now its just customary over chargeing without reason.

Very interesting exercise in real-life economic decisions.

I'm curious as to whether EMT crews feel pressure from their employers to "convince" people that they need to accept, and therefore pay for, ambulance rides.

As a recently resigned Paramedic and Supervisor that also worked as a representative in the EMS community, I can say that the EMS system in central Utah is failing fast. It is no longer about the patient, it is about egos, money and territorial control. We are at fault when we allow the government to choose between themselves and and another entity to provide our ambulance service. We were all warned that if the government run fire departments took the ambulance service away from the private agencies then the cost would go up. Starting in 2002 with the push for governmental monopoly of our ambulance services, the price for the ride according to the state was $765. That was when private agencies handled the large majority of the actual ambulance ride. Now years later the cost, according to your article, is up ony 5% unless you go with the fire department, then the cost is up a huge 57%. That doesn't even include the hundreds of thousands of tax dollars used in legal fees to obtain their monopoly.

Then there's the other side of the argument. I actually work in the EMS/Fire Department field. Many of the medical calls we deal with are frivolous; such as cut finger,flu or colds. These people call 911 as if we are there as an Instacare on wheels. There isn't an understanding of what 911 really is; 'life threatening emergency' doesn't mean a thing to them. These types of calls use resourses and are seldom paid for except by the government via Medicaid. Most of these callers act as though they are owed this medical care simply because they are on welfare, are homeless or are poor. This type of thing is what really raises the costs of medical care. And the fear of lawsuits is what causes it to happen. I actually had a call where a woman called from a local hotel, was just 'feeling sick' and had no insurance or Medicaid. Instead of being willing to go to the closest hospital, she insisted on going to one that was 15 miles away. Initially, the ambulance refused to take her, but because of malpractice they went back and ended up taking her with no reimbursement. The USERS cause this problem.

I hate it when they publish this type of article where they show the cost of a service, but don't explain what the cost breakdown is.

How much is labor for the ambulance driver and EMT's?

How much for maintenance?

What is the average cost for supplies and fuel per call?

What about vehicle insurance?

What about liability for the workers?

I would like to know the answer to those types of questions when I see articles written about how expensive a service is.

For both Fire and EMS what is done and how it is done is driven by lawsuits. If we are called to a scene for EMT's it does not matter that we do not believe that the patient does not need medical care. Our protocols dictate that we must transport the patient no matter what unless the patient is alert and oriented and able to refuse care and sign a release of care form. If these criteria cannot be met then we must transport them.

The patient may be only across the street from the ambulance but the ambulance had to drive there. The EMTs had to be on call or at the station. The ambulance had tobe fueled and stocked ready to provide medical care. The distance of the transport has little effect on the cost in metro areas. Only in remote rural areas does the distance really become a factor in the cost of the ambulance ride.

The flip side is people do die because they are concerned about the cost rather than life safety. I have had to stay with a patient until they lost conscious and then transport them because they did not want to go.

A close friend of mine is an EMT in Salt Lake City. These life saving professionals earn a wage of about $9/hour to go out and help people. The real problem as Vger noted is those who abuse the system. The emergency personnel in Salt Lake know certain people by name because they call 911 nearly every day. They spend half of their time at the homeless shelter picking up "patients" who are cold or too drunk to do anything and are then forced to take them to the hospital due to protocol. They once totaled a bill of a certain homeless person in SLC at just one hospital and it exceeded $1 million and not a penny was paid on the bill. This is why the bill for everyone else is so high in order to make up for the leeches. If you want to do a real story about the problem with our emergency care then the author should research the facts I've stated here.

I have been in EMS in Missouri and Kansas for over 16 years. I have never considered malpractice lawsuits as a guide to my treatment. I have considered the injury or illness to the patient and the patient alone. If they patient doesn't need an IV I'm not going to start one. If they fit the criteria for not needing a c-collar and long spine board then I'm not going to do it.
If they do not fit the criteria for going to the ER but they insist on going then I'll take them. I'm not in it for the money being made by my service but I do it for the patient.
When we begin to treat to ward off lawsuits is a slippery slope. As a paramedic I do not have a crystal ball to know exactly what is wrong with the patient and until I have a full diagnostic suite in my ambulance I will continue to transport.
If that brings up costs then so be it, I don't have the title MD behind my name and until I do I will continue to transport. Educating the patients is the key here folks.

When comparing Fire Department or Government based EMS to private EMS, you also have to factor in the tax dollars that were spent to support the government entity. The government provider may charge less per call, but their whole budget is paid for through taxes. Once you divide that budget by number of transports, and add that figure to the charge to the patient, you will have an accurate "cost" of goverment EMS service.

I have worked with almost every type of EMS organization in existence. Fire department based, privately owned, volunteer and career. I know from personal experience in this industry, there are no one size fits all solutions. For that matter there are very few solutions that dont create other problems of their own.

History has shown repeatedly that problem solving in EMS is always a balancing act between benefits and consequences. If you encourage the public to call when an emergency might exist, then everyone calls. If you campaign against unnecessary calls, some will not call, even when it is necessary. Some are better than others but there are no perfect EMS systems. Every community is different with different problems at any given time. Comparing two systems even in the same jurisdiction can often be the same as comparing apples to oranges.

My hat is off to those who work so hard to reconcile the financials and logistics with patient care and human resources. They have a job that physically can not be done perfectly. yet they still choose to serve us all.

Keith Waycaster, CEO
Priority Medical Claims
Beckley, WV