Funding? That's what income tax and sales tax is for.
No, ambulance service is locally provided. How much you pay depends on your insurance coverage. If you have no insurance, then you will have to work something out with the ambulance company.
Pay for 911?? Explain what you mean. I believe that landline providers (former RBOCS) pass on a tiny monthly phone surcharge, is that what you are refering to, because calling 911 is free.
Why would you make a post without knowing anything about the subject?
In our area, emergency ambulance service is provided by the fire department and that is covered by a separate tax, which is part of our property tax.
Sales tax covers other local and state government functions/services - courts, roads, parks, public works (water, sewer), . . . .
Income tax is mostly at the federal level for all the programs and services, but some states have income tax, and some cities (e.g., NY City) have income tax.
In most communities, emergency medical service is considered a hospital emergency room on wheels. So the same policies that apply to hospital emergency room service applies to ambulances, as well.
I think the original poster may have been commenting on the fact that most communities charge patients whenever EMS responds; not just when they transport the patient to the hospital. The charge is usually much less, however.
Charges for driving a patient to the hospital can be five times greater (or more) than the charges just to respond to a potential emergency medial call. Doesn't make a lot of sense, cost wise, since actually driving the patient to the hospital is probably the cheapest part of the service. But many communities send out an EMS team if there's even the possibility of their being needed - the patient doesn't really have control over whether EMS personnel show up or not. I think the difference in cost is so a patient doesn't get hit with a huge bill simply because their neighbor decided from across the street that that skateboard wipeout has to be serious enough to require an ambulance.
For example, when I was a teenager, I witnessed a person drive his car into a brick house one night. From 40 feet away, the driver looked unconcious to me so I told the first person to come out of their house to call an ambulance. It was probably a good decision, but there was no way I could have possibly known how serious he was hurt from so far away and I definitely wasn't going anywhere near that car to actually find out. I was kind of freaked out by what I just saw. Even though it didn't turn out that way, it surely could have been possible that the driver was fine and not even really unconscious. He would have been charged for the response even if he didn't need it.
In actuality, it was hard to tell whether the driver was semi-unconscious from the accident or semi-passed out from the alcohol since his injuries were basically a bloody, perhaps broken nose. But he definitely wasn't coherent when someone with a little more confidence did check to see what first aid he needed. And the ambulance did cart him off to the hospital just to be sure.
But the policies for EMS is decided by each local community, so it would be hard to say how one single community figures out what the charges should be for emergency service (especially an unknown single community).
If I call 911 for me, I don't mind paying.
If you call 911 for me, I may object to paying.
If I call 911 for you and you are charged, I don't care.
If I call 911 for you, I mind being charged.
Are you confusing 911 with ambulance service? They are not the same thing. What you just wrote makes no sense.
So is what you are trying to say is if you are seriously injured, you do not want to be saved?
my error in not being specific.
911 = emergency response. They are the same here.
First question asked = Fire, police or paramedics?
The question was, Why must people pay for 911 and ambulance service?
I ignored the fire and police aspects of the 911 call.
I don't know what country you live in, but in the US, if you call 911 (emergency dispatch), you are not sent a bill just for calling them.
Ambulance service costs will vary from town to town depending on services offered, how much is subsidized by the city/township, etc... and your ability to pay. For very poor people, there are usually services available to them to cover expenses.
Here is an example from Washington D.C..
The actual phone call is free. The phone call is all that is free.
If Fire Dept paramedics, or contractor paramedics, or an ambulance service show up at the scene (in other words, if your phone call actually results in some kind of action), then there may be charges, depending on the city you live in.
I'm pretty sure this thread is about 911 response; not the cost of the phone call.
Sacremento charges $275 or $96 (depending which fire dept responds) for responding, even when the patient doesn't require transport to the hospital.
http://www.anaheim.net/article.asp?id=372 [Broken] charges $350 per response, even when the patient doesn't require transport to the hospital. Or, an Anaheim resident can pay an annual fee of $36 via their utility bills (in addition to whatever city taxes they pay).
So, you're in a car accident - say you slide into a telephone pole because of icy conditions. An observor on the sidewalk calls 911 and a fire dept paramedic responds (although the paramedics stationed at the fire dept probably aren't actually part of the fire dept). No one in the car accident actually needs medical care. You can still be charged.
This varies city by city. It's becoming popular with small communities due to their smaller budgets. It's also starting to spread to at least a few larger cities (mostly in California) as a way to reduce costs for the city.
(Not only is this becoming common for medical response, but is becoming common for fire response in rural communities, as some might remember from a past thread about a fire dept that let a house burn down because those residents hadn't paid the fee.)
Stuff costs money. If tax money from residents don't cover the cost, then community governments either have to reduce services or charge individuals for the services they receive.
I was in a motorcycle accident and attempted to get up once I heard a passerby on the phone with 911 telling them it was serious and that an ambulance was needed.
I knew how much emergency services cost and even with insurance I did not want to foot the bill. I figured I was okay.
Due to my disorientation, I ended up back where I was face down on the asphalt half conscious with people running up telling me to lay still.
Due to the fact that it was a motorcycle accident and in the 911 call the caller felt I was in serious condition, 911 dispatch automatically called in Medivac services to take me to a trauma 1 center.
I told the EMTs that I could not afford Medivac services. Because they feared I had broken my back, they chose to ignore my request (I don't blame them at all by the way. They must always assume the worst when treating a patient). The ambulance took me from the scene to the waiting helicopter that was about 1/4 of a mile away. The helicopter then flew me about 20 miles to the hospital.
It was a 5,000 dollar helicopter ride after insurance (uninsured it would have been roughly 30,000 dollars). And even though the ambulance service drove me only a thousand feet or so, that was another 1000 dollars.
The cost of medical care to the average citizen in this country is absolutely insane. Why we haven't switched to a single payer or socialized system is beyond my understanding. I believed that before my accident and I believe it even more now.
I absolutely agree. When I was in diabetic ketoacidosis and about to die, I seriously considered not going to the hospital partially because of the ambulance bills. I only went because I had a roommate who was willing to take me. Saved my life.
Those "costs" are completely insane compared with the UK, where all air ambulances (except in Scotland) are funded by charitable donations. My local one covers an area of about 3,000 sq miles so flights of 20 miles are not uncommon. Their TOTAL operating costs are only about $5000 per day, which pays for flying several missions.
(Scotland is in a different situation, because on the islands an air ambulance servcice to the mainland is pretty much the ONLY ambulance service, unless you want to spend several hours on a ferry).
As far as I know there's no cost associated with calling 911. As for ambulance services, they're provided either by municipalities or private companies licensed by municipalities, as far as I know. And yes, the prices are ridiculously high. Just another example of wacked out healthcare costs. What can be done about this? I have no idea.
In my country, ambulance and any emergency services are costly applied to all calls. For fire alert: you pay the price we ask, we will come; or stay there enjoy your fire otherwise; For ambulance, we will come to you but later you must pay what price we ask, all is scaled on our defined prices...
I think people should pay for a particular service that they use, the higher they pay, the better they are serviced. Certainly we always want to avoid paying any and still love to be serviced well by any means. Is this the right thing to do ? Is it because many do, so do I ? It is ridiculous of me to refuse paying e.g $50 per my monthly income as of my duty for services I am using.
If 50 is too cheap then I am prepared to increase it up to 100. Why not ?
You could start by finding out how much profit those private companies make. It sounds like a pretty good business model to provide a service that people are not going to refuse, and then charge whatever you like (and for costs recovered through health insurance, people don't even know in detail what they are paying for). Whether it's a good model for affordable healthcare is a different question.
Ok, so I think most people would agree that it sucks to get socked with a large fee for a helicopter ride or ambulance ride and it would be nice if these things are tax-supported, but:
Several people just proved through their own anecotes that if the costs for these things are hidden from view, people will use them more, whether they need them or not. Heck, if there is no direct cost, why would anyone bother with a primary care physician? If you have a sore throat, just call up your local ambulance (limosine?) service and they'll drive you to the emergency room, saving you the effort and gas money, not to mention a week's wait for an appointment. That's one of my main practical criticisms of socialized medicine, that hiding the cost leads to over-use and abuse. So I ask:
What can/does a socialized medicine system do to reduce abuse of these services if they have no direct cost?
Also, regarding the cost. Cost is not as simple as it may seem and in these discussions, people tend to vastly misunderstand why it costs what it costs.
First, there is an issue of market forces involved in setting the cost and the fact that it might cost $5,000 or $30,000 depending on when and how you pay for it is not necessarily indicative of profitteering. The insurance company provides a known customer base that is useful for planning, guaranteed payment, economy of scale and the ability to negotiate collectively. A similar issue exists with airline tickets, where the same seat may cost $200 or $800 depending on when and how you buy it.
But how much should it cost on average? $5,000 for an entire day's worth of air ambulance service is impossibly low. You can't even support one pilot for $5,000 a day (that's 24 hours of pay, benefits and insurance), much less actually run a helicopter or the mobile emergency room (and its staff) contained in it. Yes, we're all just making guesses, but $5,000 a call seems reasonable to me for an average.
Ambulances are similar. You're not just paying $1,000 for a 1000 foot ride, you're also paying part of the ownership cost of the ambulance and the equipment and you're paying the crew (if it is a professional crew) to nap and watch movies in a ready-room for hours while they wait for your phone call. The gas and salaries of the crew for the time of the ride (whether 1/5 mile or 5 miles) is a tiny fraction of the cost of the ride. So that's the error people are making: they are focusing on the cost of the ride itself and ignoring the cost of the existence of the ambulance (and air ambulance) service.
This was the one and only response needed to the OP. People must pay for it because the personel won't work for free and the manufacturers of the necessary equipment won't work for free. It's that simple.
It almost sounds in the OP that they think that if you pay for it through taxes, people aren't paying for it. Surely they must not believe that though, it defies reason.
No one here is trying to argue that there is no cost to ambulance and emergency service operation. What we are arguing is that the cost is excessive. And, in many cases, prohibitive.
Whether or not the market cost of flying me 20 miles was 30,000 dollars, I cannot afford to pay 30,000 dollars. Fortunately, I had insurance. But roughly 50 million Americans do not.
In any other industry, the costs reflect what consumers can bear. Because medical care is not really voluntary (meaning you can't go without it), the costs can be inelastic. And health care providers know that.
The only real way to solve such an issue is through nationalizing healthcare so that it is not for profit. Around the world, there are nationalized systems that are not only better at treating the population, they have significantly lower overhead costs. For example, in the US, health insurance has a 30% overhead. In Canada, it's less than 10%.
That is exactly what happens in civilized countries where these things are not an issue. Yep, you nailed it. Same thing that happens in those same countries where unemployment benefits are perpetual - everyone loafs about and takes advantage of the government. That's why all those countries have 100% unemployment and massively inflated health care expenses.
Oh wait. That's right, we're the ones with the massively inflated health care expenses, not them. However could that be.
Oh really? So pilots have benefits + pay packages exceeding 1.8 million dollars per year? Well, now we know why the "free market" is ridiculous at these kinds of services.
These things would be significantly cheaper if everyone were paying for them. That's the whole point of society: a collective sharing of resources for the betterment of all. Even if an ambulance does cost a thousand dollars per day, that's infinitesimal if paid for by ten thousand people.
Not mine; it's also less than 10%.
Of course, % overhead is a spectacularly bad measure of efficiency, so we can all stop caring about it right now.
How about per capita health care expenditures?
Also bad; you're just looking at input without looking at output and value.
It's probably better than the % admin values you see tossed around, though. Those are just awful.
How about per capita health care expenditure in relation to infant mortality and average life expectancy?
Sure, grab Getzen's Health Economics and Financing for a good overview.
Infant mortality is not easily comparable across different medical systems, but average life expectancy given some initial age (e_x) can be useful.
Kinda wandering off topic, I guess.
Couple things if my simple napkin math is correct to have a helicopter on stand by 24 hours a day 365 days a year you would need 10 pilots on staff (5 teams of pilot/co-pilot) and maybe a 6th not knowing what restrictions there are on time off for pilots. Thus $5,000 a day would give you and average salary plus benefits and matching taxes of $182,500 per pilots with 10 on staff.
That does not sound crazy to me but my assumptions may be wrong.
Second how many ambulances do you think are needed per 100k in population?
Lets use your number $1,000/day/10,000 people equals 10 cents a person lets assume that you actually mean per person and not per tax payer so a family of 4 pays $0.40 cents a day for ambulance service. That makes 146 dollars a year for a family of 4 sounds great but we only have 1 ambulance per 10,000 people so you better hope its not already transporting somebody from a Hospital to Hospice care when you have your car accident.
I think we need a few more ambulances per 10,000 People but maybe that's just me so lets say 5 that would be 730 dollars a year for a family of 4 if you use the ambulance or not.
Then again 5 may still not be enough.
For example the "Downtown" Pittsburgh EMS service has 13 units with I do not know how many ambulances each they service 178 calls per day and the "downtown" area has a population of 308,000. This does not include any of the hospital run or third party ambulance services or any of the suburbs that is just the city run ems service. The Yellow pages have 90 other listings for ambulance services. Plus the fleets run by each hospital.
So then when we are all paying every year and you do not have to pay when you actually use the ambulance will you complain when you need one and none is available?
No you will say at least the people using the ambulance can at a reasonable rate although if it were for profit we would have more ambulances available to all who may need them at a slightly higher cost.
Sharing resources does not always mean the betterment of all.
The tax payed ambulance service would certainly have a union and the cost would not stay at $1,000 dollars a day for long. We all end up with less service but at least its fair.
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