July 1st, 2019
A patient’s decision about whether or not to call an ambulance should be based on medical need, but cost also plays a factor. When the cost of taking an ambulance goes down, it makes sense that more people would use them, even in non-emergencies. A recent study in JAMA found that expanding insurance coverage under the Affordable Care Act led to greater use of ambulance services for nonsevere injuries in New York City. These ambulance rides for minor injuries are expensive and could lead to EMS longer response times. So should we make patients pay a greater share of ambulance costs for minor injuries, as the study authors imply?
It’s not that simple, Dr. Surafel Tsega and Dr. Hyung (Harry) Cho, internal medicine physicians at Mount Sinai hospital in New York City, explained in an accompanying commentary:
“As clinicians who take care of disadvantaged populations in NYC, we are acutely aware of the risks of shifting costs to patients (forcing them to put more skin in the game, as it were). Not only do we see the effects of patients delaying care because of cost or lack of health insurance, but we also see the effects of rationing care.”
If patients are financially penalized for taking an ambulance, they are more likely to delay getting care, even at the expense of their health. This is especially true for ambulance rides, which can cost thousands of dollars to go just a few miles. For example, when a Boston woman got her leg caught between the train and the platform, she begged onlookers not to call an ambulance because it cost too much.
Trying to determine whether a medical problem is worthy of an ambulance ride can also put a burden on patients. Patients experiencing an acute medical problem do not necessarily know whether their condition is “minor” or “severe” in the moment. Patients should not have to diagnose themselves as having an emergency and choose between risking their financial or physical health.
Although New York City has many transportation options, these options are not equally available to all. Lower-income individuals bear an increased burden of transportation troubles, as they are less likely to have a private car, less able to afford a taxi, and live further from public transportation hubs. Public transit, while affordable, is often slow and overcrowded, which is less than ideal for someone suffering an acute injury. The increased use of ambulance services in NYC “highlights the need for improving transportation to clinics and urgent care centers,” write Tsega and Cho.