How to pay for EMS

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Veneficus

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With all the recent discussion about billing practices and how EMS is paid for, what do you propose as the most equitable system?

(it's also ok to brag about how your system is funded)
 
100% funded by taxes. (For us it's 50% by Regional Municipality/County and 50% by the Province). Don't rely on billing to fund it as poor collection rates make it a losing proposition. Allow any collected fees (we have a $40.00 co-payment) to go back to the government coffers to offset the cost, without forcing the service to rely on it.

This will likely only work in a system with public health care.
 
Depends on where you are.

I like the idea of subscriptions for rural and volunteer outfits to augment, as well as fundraisers. Otherwise: basic lifesaving services funded by taxes, any extras (transport lying down when wheel chair van is adequate or neither is needed) privately paid. People overusing service: case managed as to mental status, etc., but ?? about cutting them off somehow. Stop running expensive fire trucks to scenes somehow, and in peacetime use military med techs and Guardsmen/reservists to give them some sort of real experience they do not get lollygagging around a base hospital.
 
Mostly tax payer funded. A user fee currently exists of about $130. per call for Nova Scotia residents. The rest is gov't funded. Emergency Health Services (EHS) has about a $100 million annual budget for all ground amb. (140 units), 1 x HEMS, and dispatch center. Has about 850 full time paramedics, (50% ACP/ICP and 50% PCP). We have a population of just under 1 million people.
 
I believe that 911 should be third service or fire based with income from taxes. All other transports/standbys/etc... can be handled by IFT companies with revuene from insurance/co-pay/etc...
 
I would push for capitation... but it simply doesnt work for EMS... Unless we are involved in primary and preventative care, or can reduce high-risk groups in our population, I dont see it being a solvent strategy.

Bake Sale?
 
Cash, Charge, Lung or Kidney ? (I bet that payment scheme would cut down on abuses (just kidding))

I think the best choice is to support the down time required to keep the service available by our taxes. The actual cost of the call is to be billed and fully collected one way or another from the patient, with payment waivers to only those who were critical enough to require transport by ambulance regardless of income. In essence the sicker you are the less you pay out of pocket. The frequent fliers who take the ambulance 3 blocks for a tooth ache would be billed the most, and I say collect it out their food stamps or other government assistance if necessary. This would seriously put a damper on the abuses of the system. I do feel that there should be a subscription or insurance if you will that would allow for a broader use of services if paid for in advance for the local residents who's tax base supports the service while on standby for calls.

The most controversial opinion that I even have mixed feelings about is all heath care should be non-profit. Even to the extent of possibly capping Dr's salarys. That coupled with tort reform we might have a system that is workable.
 
For the service that I volunteer with we hold a fund drive. The residences pay per year. We then have a database and they hold a membership, which means if they get taken to hospital and we bill the insurance and the insurance doesn't pay or only pays a part of it, we do not bill them for the rest. It works the same if the pt has no insurance. If they do not have a membership, the pt will get billed for the balance, if they do not pay, then they go to a collection agency. The fund drive does well for us, and we minimize losses. Being that we only run 500 calls per year, every penny does count for us.
 
funded with public monies.

you turn it into a something that takes PT's money we stop being good Samaritans and are nothing more than a business focused on profits.

non-profit government run. equal access
 
Queensland Ambulance Service in Australia is funded through a levy on, of all things, your electricity bill. It's $100 a year (AUD).

In New Zealand services are part-funded as a percentage of Government health spending (which comes from taxes) and the two larger services also rely on donations, bequests and fundraising to make up the shortfall while the two hospital based services do not. They are funded as a portion of the District Health Board funding which adds another level of complexity. All bar one service here part charges (around $60NZ) but that is a very contensious issue.

The UK services are funded as a part of the National Health Service (NHS).

I really like the idea of what Queensland is doing; a small levy on something everybody has which means we all chip in and get free access. The Government could be sort of co-signed into ensuring a minimum amount of funding to cover to expendature or something under the Health system.
 
MrBrown said:
Queensland Ambulance Service in Australia is funded through a levy on, of all things, your electricity bill. It's $100 a year (AUD).

In New Zealand services are part-funded as a percentage of Government health spending (which comes from taxes) and the two larger services also rely on donations, bequests and fundraising to make up the shortfall while the two hospital based services do not. They are funded as a portion of the District Health Board funding which adds another level of complexity. All bar one service here part charges (around $60NZ) but that is a very contensious issue.

The UK services are funded as a part of the National Health Service (NHS).

I really like the idea of what Queensland is doing; a small levy on something everybody has which means we all chip in and get free access. The Government could be sort of co-signed into ensuring a minimum amount of funding to cover to expendature or something under the Health system.
Click to expand...

I kinda like the queensland thing.

Taxing stuff people don't really *need* like phone service and cable or satellite and putting those taxes directly to public services. Not gov't agencies, but *direct* government action like libraries or emergency medicine.

It taxes those who can usually afford the tax. While providing services to all regardless of economic status.
 
Our state wide service is currently funded through the health system and by subscription. That is, most people have Ambulance membership which costs about $60 a year for families, if you don't have membership then 1) you are an idiot, and 2) you pay the full price for a ride. The ratio of funding is about 60:40, tax$:subscriptions & fees charged to idiots who don't have membership, supporting a 450 million dollar budget:

-2500 paramedics + 500 support/admin staff,
-850 vehicles
-5 HEMS choppers
-4 planes

Currently I believe they operate at a loss.

I believe the ambulance service should be funded through the medicare system. That is, through tax dollars, with a ~$40 co-payment per each use, or ~$5-10 pention/concession/healthcare card holders. This would make the ambulance service similar to many other healthcare organization in this state, in regards to cost (prices mentioned are roughly that of PCP and prescription medication co-payments).
 
St John and the two DHB services part-charge for callouts and this is really a very unsustainable situation as it runs now.

A portion of the debt is written off because of non payment (I don't want to say a "significant" portion but it's roughly 20-30%) and the part charge scheme creates both contractual and bugetary limitations (with the Ministry of Health) as well as problems around access, legality, forecasting and public relations.

Like Australia you can buy into the St John scheme where you get free cover by paying a small fee each year.

I really don't like the current part-charge scheme (although am not against the idea of a small part-charge like when you go to the doctor) and think for simplicity the ambulance service really should be free to the end user.
 
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