Ambulances too China incentives of the day

The BBC has an interesting report on ambulance services in Beijing.  Up until now, ambulance drivers could decide themselves how much to charge people for their services.  I’m assuming these weren’t listed or known beforehand either.  This seems ripe for abuse given that the patient will be desperately wanting to get to the hospital and in no state for bargaining.  According to the article, most Chinese on social media didn’t even know that ambulances charge at all.  That must come as a big shock then when they get hit up by the driver.

So what did authorities decide to do?  Decree that ambulances “be fitted with taxi-style meters in an effort to allay public concerns about overcharging.”  Hmm, this doesn’t seem to be the most incentive compatible policy either.  As one social media cynic (read: realist) pointed out, “Don’t rule out ambulances taking a detour when using the meter.”  At least when you’re in the backseat of a cab, you can watch where the driver is going.  In the back of an ambulance in an emergency situation, that’s not going to be very feasible!  Don’t get me wrong, I’m in no way advocating free ambulance services, but there has to be a better policy than this.

That is from Cherokee Gothic.

Comments

Beijing ambulances are more like our taxis, or at least that was the case back in 2001 when I rode in one as a patient. That's because the other cars ignore the siren (when the ambulance drivers bother to use it). You sit in traffic like everyone else! My ambulance ride took over an hour ...

Taxis don't take kickbacks.

Rumor has it Chinese hospitals do pay kickbacks to the ambulance drivers and then decline to release the patient. For medical reasons obviously.

Same in Greece, except hospitals pay ambulances to bring patients to them. Not usually a big deal since most of the time people in ambulances are not so injured that they'll die any minute.

While I would not hold too much hope here it would be interesting to see if there were also claw-back rights or other liability the changed the incentives for the driver. That said, I suspect one of the best incentives would be having some of the top CP members on one's smart phone to show the driver.

Uber has solved this problem. If my Uber driver takes an inefficient route, I email Uber and they refund me.

+1

This is the correct solution. Also: when uber 1st did this for me I was amazed. Perfect service.

Or they can refund your estate..

This is why regulation is necessary. It is utterly useless to an individual for her estate to file suit. Regulation will ensure that instead the government files suit after you die.

I do this all the time. I sometimes lie about just because I was drunk and don't want to pay the fare. It's not worth Uber's time to actually review the route, so I profit every time. Those fools don't even ask why I gave the driver full stars despite him going the long way.

What? They have emailed me the exact route that the cab should have taken. I was in SF.

What's the justification for not advocating free ambulance services?

This is a case of Poe's law in action.

Free? You mean paid out of general taxation. The usual concerns with anything socialised: rationing of services; staff watching the clock instead of watching the customer; management who only care about their political paymasters rather than the organisation's reputation.

Take a look at ambulance services in Britain's "free" National Health Service, which many deluded Brits believe is the eighth wonder of the world:
http://www.bbc.co.uk/news/uk-england-london-35581160
http://www.enfieldindependent.co.uk/news/14404303._I_have_nightmares_about_what_happened___Man_lay_in_road_for_hours_after_horror_crash/
http://www.theguardian.com/commentisfree/2014/dec/30/are-five-hour-waits-ambulances-sad-state-healthcare-system

The ambulance driver taking a circuitous route to the hospital is no different from the physician taking a circuitous route to diagnosis and treatment. Exploitation is the bedrock of a free society.

A physician taking a 'circuitous' route in patient care is documented at least for the patients and payers to see. And then possibly for medical peers and lawyers. If running significantly outside the medical standards of care, this may raise eyebrows or worse for the attending doc.

No, being exceedingly thorough is rewarded by the patient and lawyers. It is punished by the insurers.

Thorough is different than circuitous. I read circuitous as intentionally round about for gain.

Insurers are more than happy to raise premiums to cover any arbitrary level of thoroughness, as long as there is a regulation requiring it, to ensure the consumer is helpless to avoid the higher premium costs.

Thoroughness with any medical situation would be relative and grounded in the particulars of the related medical standard of care. You might call these standards as regulation, but typically there is a wide berth given for variation of medical practice with any one doc and with individualization of care for any one patient.

Importantly, if we finally overcome our devotion to 'freedom' (as the conservatives call it), we can experience exploitation-free socialism. I'd much rather have a highly-skilled, highly-motivated, and highly-ultruistic federal union employee be responsible for my life and death, than a greedy, profit-motivated, private-sector scrooge, who is only motivated by not being sued, not being fined, and not losing a sole source of income.

Libertarianism using fallen human nature to advocate for reforms that unleash even more oppurtunities for fallen humans to do bad things.

What do you mean? It's a market baby. Pay what you can. Pay what you must. Oh, pay you will.

Don't forget the pay IF you can part of that too.

Meanwhile, here in the USA, the exact same system is in place. The ambulance company (or municipality) will charge a base fee plus mileage. There is no law that requires GPS tracking. Some companies have GPS tracking and will obtain mileage automatically, while others will have the driver look at the odometer and write down the mileage.
So I ask, is there ever an incentive for the driver to take a longer route?

The base rate is high enough, I've seen $600-1000, that the mileage expense, $10-20/mile, is relatively trivial. In most cases it probably makes more sense to get to the next call ASAP.

Also not aware of too many EMS paramedics getting bonuses based on P&L performance.

Somebody in China has clearly been boning up on the American health care model and decided that it is a good thing. Go figure.

Yeah, because cheating Chinese paramedics has everything to do with our health care model...

It isn't cheating until they make it illegal and yes, pretty much the entire health care billing model of the United States involves massive cheating with almost no legal restraints which is why we pay providers in the U.S. far more than any other country in the world does for exactly the same services, even adjusting for purchasing price parity.

They could also mandate providing mapping of the route taken. I'm pretty sure there are loads of apps already fitted out to do this.

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