Assessing the High Costs of Ground Ambulances & its Emerging Affordable “Alternatives”
Authors: Alina Zou, Avery Ma, Helena Huang, Weiwei Liang
When you hear the word, “ambulance,” people often think of life-threatening situations where patients are rushed to the hospital to receive care from medical professionals. However, what comes after that? If you were that patient, the last thing you want to see is probably a big bill from your insurance or hospital. But the thing is, that happens more often than desired. On top of that, ground ambulance costs, unlike air ambulances, are not protected by the No Surprises Act, meaning that there are no federal laws governing how fees may be charged. In this newsletter, the discussion will focus on the cost breakdown of ambulance rides in the US, alternative options for calling the ambulance that became popular in the US, and in low to medium-income countries.
Across the US, ambulance services include Basic Life Support (BLS) and Advanced Life Support (ALS). BLS is also known as the “first-step treatment,” and provides basic essential emergency treatment excluding services such as cardiac monitoring for patients before they reach the hospital. ALS, on the other hand, includes more advanced and specialized equipment to provide immediate and comprehensive care during the transportation process to the hospital. Both services are staffed with EMTs and other trained personnel to deliver immediate care to the patient. In some instances, patients may be able to choose which service they want to experience, but the majority of the time, the doctors make this call based on the patient’s needs and location.
Mini cost breakdown of ambulance services in the US
According to CareCredit, the average cost of a BLS ambulance is around $940, while the average cost of an ALS ambulance is around $1277. ALS provides more expensive treatments with more advanced medical equipment such as the ECG and Cardiac monitor, and the patient who is in need of ALS most likely requires more medications and services done by the paramedic crew. The comprehensiveness of treatments depends on the severity level of the emergency cause, and price often forms a positive correlation with that.
Ambulance charges vary significantly between different states as well, taking into account costs such as Mileage charges. In Massachusetts, for instance, researcher Diana S. Váscones from the Massachusetts Health Policy Commission stated that insured patients pay an average of $761 for an ambulance trip from a municipally-owned emergency medical services company nationwide, as compared to a $1,578 charge in Massachusetts (Wbur News). Similarly, the price for an ambulance ride has risen from $900 to $1380 in 2023, an approximate 54% increase in BLS ambulances in New York. In Los Angeles, California, the basic ambulance ride costs around $1,800, while advanced care costs $2,500 (MaisonLaw). As seen so far, ambulance costs vary largely from state to state.
Although ambulance services are certainly necessary for emergencies, the pricing remains largely unaffordable for many. In the following section, we will dive into alternative solutions used by the US and other lower-income countries to tackle this issue.
Uber as an alternative to ambulances is feasible but remains limited
A substantial portion of ambulance costs is attributed to the perpetual staffing model essential for round-the-clock emergency response. Uber, with its widespread presence and 5.4 million drivers globally (1.5 million in the United States as of 2023), offers a viable alternative to address emergency situations. In contrast to the extensive coverage and penetration of Uber in the U.S, HMP reports that there are more than 1.03 million personnel who are licensed as emergency medical technicians, paramedics, and other levels of EMS patient care and 24,926 Ambulance Services businesses in the US as of 2022. Take a city like NYC for example, it alone houses 347 ambulance and emergency medical transport organizations, indicating a seemingly sufficient supply. However, demand remains inadequately met due to cost-related factors. Data from EMS World reports an average of 2,408 EMS calls per calendar year for an ambulance, (“breathing problems” and “chest pain” are some of the most regular calls) equating to approximately 6½ calls in a 24-hour period per unit. Despite seemingly ample supply, the high cost associated with ambulance services dissuades potential users, resulting in underutilization. This discord between supply and demand underscores the economic challenges that traditional ambulance services face.
In terms of cost and speed considerations, Uber and Lyft emerged as promising alternatives. The extensive coverage of Uber in each city and the dynamic pricing model based on upfront estimates, trip duration, and distance pose as a cost-effective solution. Estimates suggest an average cost of $1 to $2 per mile for an Uber ride, significantly lower than the $15 to $20 per mile for ambulance services. However, the extent to which Uber and Lyft can substitute for ambulances is inherently limited. Ambulances possess vital medical components, including oxygen supplies, bag valve masks, defibrillators, emergency medications, and trained medical professionals. In addition to the medical devices installed within the ambulance, medical personnel also fulfill critical functions: emergency care assistants collaborate closely with paramedics in times of crisis; emergency medical technicians function as responders to incidents, assessing, triaging, and administering lifesaving treatment; Lastly, paramedics perform an essential and immediate role, often being the first responders to the scene and take control of life-threatening situations. Paramedics and emergency medical technicians (EMTs) evaluate patients for injuries and illnesses, administer critical medical treatment, and transfer them to medical facilities. All these specialized equipment and medical personnel also partly explain the high cost of ambulances.
Based on Gold Cross Ambulance Service, patient portfolio studies reveal that ambulance usage primarily caters to potentially life-threatening conditions, such as traumatic injuries (21.4%), abdominal pain (12.3%), and respiratory distress (12.2%). The urgency of life-saving interventions necessitates prioritizing the availability of specialized medical equipment, emphasizing the irreplaceable role of ambulances in emergency healthcare.
In conclusion, while Uber and Lyft present a cost-effective and efficient alternative for non-severe cases, the indispensable medical capabilities of ambulances remain essential for responding to critical, life-threatening emergencies. Balancing cost considerations with the imperative of timely, specialized medical interventions underscores the nuanced landscape of emergency healthcare alternatives.
Emergency medical services in developing nations and a call for practical solutions
Access to emergency medical services remains a barrier in many developing countries, as it is often unaffordable or inaccessible. Transportation remains one of the most challenging problems. Based on Ramdhan et al. (2018), The history of the term "emergency medicine" traces back to the French Revolution, when military medical surgeon Dominique Jean Larrey proposed that severely injured soldiers be taken to a rescue station and operations should be carried out immediately rather than waiting until after the battle. This emphasis on immediate care for injured soldiers highlighted the crucial role of transportation in saving lives. Fast forward to today, and this remains a significant hurdle for many nations grappling with limited resources.
The transportation conundrum
Transportation, encompassing roads and networks, tends to be poorly regulated in regions with low to medium-income, such as in the Middle East and Southeast Asia. Take Pakistan, for example, where physicians encounter difficulties in referring patients to higher-level facilities due to subpar transportation and communication systems (Razzak et al., 2008). Furthermore, because of the uneven distribution nature of medical resources across regions in these countries, it is even more difficult for the public to access formal emergency medical services. Some studies have been conducted to investigate alternative emergency medical services, such as first aid training for locals, to address this quandary.
Exploring Alternatives in Ghana
A research investigation done by Mock et al. (2002) examined the efficiency of a program that builds on Ghana's existing, albeit informal, pre-hospital transport systems. The great majority of injured individuals in Ghana are transported to hospitals in commercial vehicles such as taxis or buses. In the study, 335 commercial drivers were trained in a six-hour basic first-aid course and compared the process of pre-hospital trauma care provided before and after the course, as reported by the drivers themselves.
As the survey results showed, there was a significant improvement in the provision of first aid components compared to what was reported before the course: crash scene management (7% before vs. 35% after), airway management (2% vs. 35%), external bleeding control (4% vs. 42%), and splinting of injured extremities (1% vs. 16%). When transportation services are limited, first aid training is a great “alternative” provided to people who are most likely to have first contact with the injured person and may improve the rate of saving the injured person's life.
In conclusion, despite the high cost of ambulance services, they remain crucial during times of emergencies. Alternatives such as third-party transportation like Uber/Lyft pose as good and cheaper options for individuals who exhibit mild symptoms and do not need immediate care administered by medical personnel. In lower-income countries like Ghana, first-aid training courses also help to improve the public’s abilities to respond to emergency situations prior to professional medical care. Overall, ambulances are still very much necessary, but more affordable options are emerging to increase accessibility to all.
