Uber as an ambulance substitute

Using an ambulance to travel to the hospital in an emergency can cost upwards of $1,000 USD. Now research demonstrates that a significant number of people are instead choosing Uber to perform the same service.

The paper – currently being peer reviewed – examines the effect on ambulance usage as Uber was introduced to 766 cities across 43 states. According its findings, even the most conservative estimate shows a seven percent reduction in people traveling via ambulance where the service is available.

Here is the full story, via Jeffrey Deutsch.  File under “Even with surge pricing, bending the cost curve.”


In France the public health insurance service refunds taxi bills for sick people transport under certain conditions. What does Uber adds to cab services again?

You still pay for it, just indirectly. The US system may suck but it does provide the most direct incentives. There, revealed preference tells us that ambulances are overkill.

You don't pay for it 'indirectly' - it is simply part of the health care services you pay for directly though being covered by the health care system.

The American idea of 'health insurance' tends to be exceptional - pretty much everywhere else in the industrial world, to a greater or lesser degree, you pay for healthcare, with the amount collected and disbursed in rough equivalence per year.

Rough equivalence for the entire budget of everyone using health care - not you specifically.

Strangely, the such systems cost at least a third less than the American system, while providing health care that is just as good (the French health care system stacks up very favorably to the American system, which is a polite way of saying the French system is broadly better).

The two worst systems in the advanced world are probably the UK NHS (National Health Service) and the US NHS (National Health Shambles).

See below for another perspective, from a British citizen. But sure, compared to most of Europe. the NHS comes out behind.

But read some Americans reporting on their use of the NHS to get an entirely different perspective on American health care.

"Rough equivalence for the entire budget of everyone using health care – not you specifically."

Who pays for the fire department? Roughly everyone....but most people don't ever have a need to call the fire department? How should the fire department be paid for? One method might be to take their budget, divide by the number of calls and roughly charge each person that call's cost (you could still use homeowners insurance so it's not like you must get hit with a $175,000 bill just when you're confronting a house fire). Another method might be to say being within range of a fire department is just part of the cost of a house therefore it should be paid by taking the fire department's budget and dividing by all those it covers.

Interestingly, you end up roughly in the same place. In the first case if insurance is covering all the homes, it will end up charging everyone whatever would be charged in the second case since there's no way for the insurance company to know which houses will catch on fire. Even if insurance doesn't cover everyone, you could look at those opting against coverage to simply be 'self-insuring' either taking a 'bet' against the insurance company or paying themselves the saved premiums that would otherwise have been paid to the insurance company.

Well, though the term 'health insurance' is used in Germany, the 'health insurance companies' are actually called 'illness funds.'

'How should the fire department be paid for?' - Interesting question, considering that there are both volunteer and professional fire departments. However, the German illness funds have been making a profit for the last few years, as the outlays have not been as high as the collected money. Which does not really bother anyone, and no one sees much need to put a lot of thought into it - after all, some years will have higher costs anyways.

'you could look at those opting against coverage to simply be ‘self-insuring’ - In Germany, health insurance is mandatory in a way that makes the no longer applicable American individual mandate look extremely patchy.

Here's my thinking. If the price of an ambulance ride is $1000 then that implies owning an ambulance is an insanely high profit business. What are the startup costs? $200K perhaps? Seems like something Uber could hop right into directly.

Or owning an ambulance is not a high profit business, it's just that there's lots of downtime coupled with low reimbursements from many rides leading them to try to soak the person who comes along now and again who either pays out of pocket or happens to have the 'wrong' coverage with a $1000 bill. The regular people plus the few 'suckers' at the end of the day produce a business that makes a modestly ok business in the medical industry.

This is the problem with the US healthcare system, in attempting to be 'individualized' we end up with a reverse Bingo game where random people get soaked with absurd costs by constantly changing rules which are impossible to navigate even when you aren't bleeding or having a heart attack.

In the past there have been private subscription-based fire services, houses that subscribe would have a medallion on the home to indicate coverage. In principle private payment would allow people to reduce risk by self-insuring, for instance by installing fire suppression sprinklers common to commercial construction. But fire services are cheap enough that most people don't care, and most of the inefficiencies are far removed from individual action, such as the failure to type-certify airtankers and excessively fight wildfires from the ground.

The problem with ambulances is they are not forthright about their prices, and people may not know they only need to pay reasonable and customary charges. For the price they pretend to charge, you could buy an ambulance, transport yourself, and sell it to someone else at the end of the day for less than they charge. But they are overregulated and not set up to dispatch uber, so uber probably wont get into it real soon.

In the past there have been private subscription-based fire services, houses that subscribe would have a medallion on the home to indicate coverage.

If my next door neighbor's house is on fire I am going to lend him my medallion.

I am going to lend him my medallion.

Look at it first. Bet it says somewhere non-transferable. Will he pay for your defense on fraud charges?

Uber is faster, more reliable, and cheaper than taxis in every city in the US except NYC where there are pros and cons for each. I don’t know about France, but I would expect something similar is true, especially since being unable to find a cab in Paris is what started the idea of Uber.

Refunding uber rides isn’t a bad idea since even a small drop in ambulance usage is probably worth it. But it might encourage too many people to avoid ambulances who shouldn’t (get sued for dying in an uber), or people take $200 surge priced ubers for a routine check up and try to write it off.

Did you guys see this? What do you think?


I think the reserved congressional and Supreme Court justice parking spots at National say all you ever needed to know about the subject.

Though it seems as if expansion will cause some problems - 'Members of Congress and Supreme Court justices are set to lose a major perk at Ronald Reagan Washington National Airport this summer.

The Metropolitan Washington Airports Authority will begin blocking members of Congress, Supreme Court justices and international diplomats from using 89 VIP parking spaces near the airport's terminal, in June. The parking spaces need to be used by construction crews working on the airport's expansion to handle an increasing number of passengers.

"We're closing the 'restricted lot' at Reagan National effective June 30 to make room for adjacent construction of the new security checkpoints," an MWAA spokesman told WRC. "Contractors will use the lot to access the worksite and stage equipment and supplies until 2021."

The VIP spaces have been a popular benefit extended to all 435 House members and all 100 senators. Washington Dulles International Airport offers a similar privilege.

They won't lose out on their Reagan National parking perk entirely, though, as they will still be able to park for free in the airport's garages for the next four years. According to WRC, congressional members regularly use that benefit, which cost taxpayers more than $132,000 in 2015.' http://www.washingtonexaminer.com/congress-supreme-court-to-lose-vip-parking-perk-at-reagan-national-airport/article/2621341

There are 436 House members and 102 Senators.

Totally wrong, too bad you can't delete comments here Mark.

There are a few non-voting members of the House called 'delegates' https://ballotpedia.org/United_States_congressional_non-voting_members, but there's actually 6 of those not just 1. And there are no extra non-voting Senators.

Jerome, All you listen to is fox news. This has been debunked by the airline and you should do your own research.

Are you a Russian Troll or just careless or lazy

'This has been debunked by the airline'

If you say so, but I am fairly confident that airlines make sure members of Congress, regardless of party, enjoy the friendliest of all possible skies.

Why should clockwork do his own research? He is basically a porn addict, what value would there be in someone researching porn and discovering the models aren't quite as good looking irl or the stories don't really ever happen? Most porn addicts have the taste to center their porn on things that are actually pretty good (sex, food). Clockwork enjoys faux-muckraking porn about the little guy getting screwed by politicians (only of the opposite ideology of course).

More seriously, do I think airlines want to avoid offending members of Congress? Sure. Do I think ever airline employee is equiped with Google glasses that send a zap the moment a Congressperson is recognized causing them to randomly pick people out to screw over? No. Pretty easy to show here if you think it out:

1. Why was the Congresswoman originally slated to fly less than first class? Airlines could automatically put all congresspeople in first class thereby avoiding that embarrassing bumping of 'regular people'. Clearly she almost certainly has flown non-first class before, in all those previous flights were the first class seats all occupied by Senators? I doubt it, so why do the 'bump' on this flight just to curry favor?

2. We've seen multiple times before airlines have little to fear from angry customers so will often treat customers like shit, blame customers for their own mistakes, even use violence against customers and the only compensation they want to offer are 'vouchers' for victimized passengers for customers to buy more services from the same airline.

So what probably happened? Airline probably did cancel the woman's seat by mistake, then sold an upgrade to someone else, and then stick the woman in a nice but lesser seat. Crappy service to the customer indeed, but hey at least they didn't beat her and drag her off the plane because they wanted to fly an extra pilot to her destination to pick up for someone who called out.

You do realize that Jerome, the original poster, and I are two different people?

I am not all that interested in anyone's outrage porn, especially when delivered with a partisan approach - members of Congress are members of Congress first, and members of a party second. Which is why both Democratic and Republican members of Congress get to enjoy the use of those well positioned and free parking spots at National.

You do seem to be defending the idea that the Fox story was more about a Congresswoman screwing a 'regular person' rather than really another case of poor airline service to its customers. To be honest DC is a 'company town' and that company is the Federal Gov't and the VIPs in the Federal Gov't travel by plane far more often than the top executives of most companies. Doing a VIP parking lot to get them in and out faster is elitist but is probably more sensible for everyone in the larger picture. Same thing for private jets.

'You do seem to be defending the idea that the Fox story was more about a Congresswoman screwing a ‘regular person’ rather than really another case of poor airline service to its customers. '

I wasn't defending anything, just merely pointing out to Jerome that Congress has a long tradition of treating itself well, as noted by the parking sports at National.

Followed by the comment on the debunking, where I basically said that who cares about the debunking, members of Congress have a long tradition of making sure they are treated well, regardless of party.

'Doing a VIP parking lot to get them in and out faster is elitist but is probably more sensible for everyone in the larger picture.'

Especially considering how empty that lot area tended to be much of the time - it was probably more heavily used back when Congress was essentially in charge of domestic airline destination scheduling.

I suspect the airport runs the parking lot at National, not the airline that bumped a woman from first class. What does that have to do with the story?

It hasn't been debunked by anyone. The airline is trying for some damage control. What's easier to believe, a DC school teacher books a seat, cancels, but shows up anyways for the hell of it, or Sheila Jackson is an asshole?

The story by the airline is absurd. What's most amazing about it is that partisans will swallow it.

Jackson likely was booked in economyt for some reason (mistake by staff, abiding by sending rules, whatever) and when she got to the airport, or when her staff noted that she was economy, they called the airline and demanded 1st. The airline bumped the passenger who paid for their ticket with miles.

The only 'scandal' here is that the airline didn't come clean with their 'policy' wrt Congress people and/or Jackson.

I would assign probabilities as:

80% airline mistaken cancelled the person's ticket, used the seat to give to their next customer.

20% possibly the person themselves made the mistake and doesn't want to admit it or doesn't realize it.

Lol, wut?

Are you kidding me? Is it possible to be that partisan?

I know the concept of airlines treating their paying customers like shit is hard for you to believe after multiple incidents of them actually using physical violence against fully paying, behaving customers have hit the media. The nation is praying for you.

"In a public statement, United blamed the problem on the passenger cancelling her own flight via the mobile app.

After thoroughly examining our electronic records, we found that upon receiving a notification that Flight 788 was delayed due to weather, the customer appears to have canceled her flight from Houston to Washington, D.C., within the United mobile app. As part of the normal preboarding process, gate agents began clearing standby and upgrade customers, including the first customer on the waitlist for an upgrade."

I believe United when it said it had electronic records to show that the passenger canceled her flight.

You believe Fox News.

It's $80 here, $50 if treated on scene.

Where's "here"?

The private ambulance business in Ghana is fascinating. So many blinged-up former German/Korean ambulances emblazoned with religious messages. Just glad I never had to use one.

People have been using taxis instead of ambulances for years (even where they're free, see Trainspotting for instance). I must admit I'm not familiar with Uber (perhaps I just live somewhere with competent taxis) but when it comes to going to hospital is Uber really that advantageous over any other private hire car?

Sure, of course an Uber driver is likely to take someone in cardiac arrest or dripping blood from a major wound.

This sounds a bit like American dental care being overpriced - apparently there are anecdotes of Americans who simply wait until a rotten tooth can be easily pulled out by themselves without ever wasting their money on a dentist.

Well, yes, calling an Uber for a life-threatening emergency is probably a bad idea. But not everybody who needs to go to the hospital has a life-threatening emergency, and an Uber or taxi is probably fine for a lot of cases.

That said, it's surprising that they found such a large effect. Compared to an ambulance, the price difference between Uber and a taxi would be insignificant, so why would the introduction of Uber matter?

'But not everybody who needs to go to the hospital has a life-threatening emergency,'

In which case, why would they be calling an ambulance?

Which leads to the observation that the U.S. seems fairly unique. Generally, Germans only call an ambulance when it makes sense for medical professionals to show up - slice your finger to the bone, and you get driven. And if you are British, you marvel at how wretched the German medical system is, wasting 15 minutes dealing with an insurance card and the circumstances of the cut (work related) before a doctor looks at it - unlike in the UK, where it appears none of such paperwork exists, so patients dripping blood are seen by a doctor immediately, essentially.

And to the best of my knowledge, if you take a taxi to an ER in Germany, you can get reimbursed for it - even less incentive to use an ambulance.

Some people call an ambulance because they have no other way to get to the hospital. They do not have a car, or they are sick enough where they shouldn't be driving, and there is no one else immediately available to take them.

Because taxis are/were often impossible to get.

A ride in an ambulance might be more expensive than you think; http://www.startribune.com/minnesota-first-responder-charged-with-stealing-from-wallet-of-victim/321338741/ This sort of thing isn't uncommon.

Perhaps because uber has a far better logical system that existing car services, so that you can actually get response time (minute) competitive with an ambulance.

People bleeding or in cardiac arrest are still probably taking an ambulance. But the vast majority of ER visits are a little less urgent and don{t need a medic en route. Break your arm - you probably dont need an ambulance, but dont really want to wait 30mins or more that a cab company might quote.

It is really sad when such essential services are priced so exorbitantly regardless of whether the state insurance, private insurance, or the individual is responsible for footing the bill. I still remember never bothering to call an ambulance when I broke my wrist in Perth, Western Australia, instead relying on a friend to drive me to the emergency room. It was cheaper and faster.

Did you really need that ambulance though? An ambulance is always going to be much more expensive than your friend driving you, unless by cost shifting.

So it has come to it in America. Ambulance panels. Maybe the sick should be forced to pull the ambulances all the way while they are whipped like dogs. It would save money.

This paper has a problem.

It did not include taxi service and substitution between taxis and Uber for the same customer.

Uber rates in places like Chicago, for example, are lower than taxi rates ($9.20 v. $6.20), so you will have persons who took a taxi to the hospital now taking Uber to the hospital. In other cases, Uber rates are very similar to taxi rates. If Uber's entry caused the shift, where were taxis in the past.

Second, the paper makes no mention of the growth of high deductible plans under ACA and its effect on EMS usage, but evidently the healthcare industry does see this as a cause for the drop in usage: http://healthcare.intermedix.com/blog/initial-affordable-care-act-impact-on-ems-reimbursement Moreover, payments based on performance and management give an incentive to hospitals to have patients use alternative forms of transport. https://icma.org/articles/ems-era-health-care-reform

Yeah, before Uber entered there were no taxis. And, this paper proves it.

OK except ACA plans are covering maybe 9M people at most. Even assuming ALL of them are high deductible, the US population is around 323M. Less than 3% of people calling an ambulance, then, would be expected to have an ACA plan.

Second problem, if you have a high deductible plan and are going to the hospital, you're probably going to max out your deductible anyway, the ambulance isn't going to matter as much...

Boonton, Hospitals are being reimbursed more on the basis of performance, and not by procedure. If you had read the materials, you would have seen that discussion, and you also would have read about how the Affordable Care Act is impacting both the patient and providers choice of services.

And, the paper still does not account for the existence of taxis in the before and after period, nor does it even mention the changes that were also explanatory occurring during this period. Period.

In both the ACA is tossed out as a throwaway line without any real effort at analysis. I repeat again only 3% of the population has an ACA plan. If everyone of those plans are high deductible (and they aren't), that still doesn't alter the fact that most people calling an ambulance will be covered by something other than the ACA plan.

It also doesn't change the fact that almost any trip to a hospital is going to produce a bill in the thousands. So much for your high deductible in that case, if you were on the fence between uber or an ambulance can that really make the difference?

Boonton, Evidently you haven't read the articles, so let me summarize: !) Hospitals that get paid for performance, and plans that reward thusly, inform patients not to return to the delivery room, or if they do, not use the ambulance; 2) ACA plans that are high deductible impose the cost of ambulance on the insured, whereas in the past, the uninsured would use the program of not paying; 3) Cities are using alternatives to reduce ambulance usage.

Finally, you pose the choice as Uber or an ambulance, but the choice is Uber, an ambulance, and a taxi. Taxis have been around for many years; are in the same market as Uber; and thus its entry is unlikely to have been the "cause" of ambulance decline when all of the other items I mentioned above were going on at the same time, and which, by the way, the authors of the paper failed to mention.

You mention 'returning to delivery room', are you thinking of cases where expecting parents call an ambulance because they think the mother is going into labor and it turns out to be a false alarm? I can see how insurance plans can 'incentivize' hospitals...namely not letting the hospital bill for multiple 'false alarms' and expect them to figure out how to minimize the emergency 'she's going into labor' calls. But how many ambulance calls are related to labor?

It also doesn't change the fact that if you are calling an ambulance you are expecting to blow your deductible. There is almost nothing you can have done at a hospital these days that doesn't product a huge bill so if you have a high deductible plan, going to the hospital means you've accepted spending your whole deductible whether or not you use an ambulance.

Finally I'll point out when you say 'ACA plans that are high deductible' you are undercutting your argument. Yet again ACA plans are less than 3% of the population so to the degree ACA plans are changing ambulance use you are talking about 3%. If every ACA holder opted to uber/taxi rather than call an ambulance that's 3%. If half of them do that would be 1.5% fewer ambulance calls. Can you show me how that isn't anything other than statistical noise rather than a pattern that can clearly be demonstrated from data?

Boonton, I meant emergency and not delivery room.

My only error.

Boonton, This is just simple economics. Ambulance $1000; Uber 6.20 and taxi 9.20. Author sets it up as competition between Uber and ambulance, and claims ambulance drop is due to Uber, when taxi existed in the market before and after Uber came in the market. If you think the marginal difference between Uber 6.20 and taxi 9.20 is the cause of the shift between ambulance $1000 and Uber entry, I have a bridge to sell you. A three dollar difference between uber and taxi does not stand up to the $1000 difference between uber and taxi. So, look at the sources that I provided and see what others say, and question what you read if an author does not include in a before and after market analysis one of the competitors that is equivalent in both periods.

I agree the different between either taxi/uber and ambulance is huge so people would have opted out of ambulances long, long ago even before Uber came along. However, high deductible plans doesn't really explain it IMO. Even with a low deductible plan, that just increases the incentive for the insurance company to provide incentives to push patients to use taxis...why did we not hear about HMO's offering people $50 credits back int he 1990's for taking a taxi? Not bad press, they had no problem back then getting bad press for making women leave the hospital immediately after birth or denying kids 'experimental' treatments.

I think what we might instead be seeing is a game of monopsonies (monopolies of buyers). Imagine if an insurance company covered 60% of people in a town. Would they pay $1000 for ambulances? Certainly not, worse came to worse they would simply buy the ambulances themselves and set up their own company to serve the town. If they did what would they charge the other 40%? Well now it's not just about the price/profit dynamics of ambulances but whether you're punishing your competition in the insurance business. But then it's not that simple, probably a huge chunk of that 40% is covered by medicare/medicaid/VA....so maybe it's like 30% covered by gov't buyers who set their price with 10% 'random'. Result: if you happen to be the visitor with 'odd' insurance you're screwed.

What if years before no particular insurance or provider had more than 10% of the market? Prices would probably be higher than a taxi (more expensive wheels and more highly skilled drivers after all) but would feel more 'reasonable' to people. Do we have an efficiency problem or a monopoly problem?

Can you quickly call a taxi directly to your location as easily as Uber? And do you get a map come up on your cell phone showing the driver of your ride, where he or she is at every moment, and when they will arrive at your location?

I'm asking as I have not called for a taxi in many years.

Here in the inner suburbs of Sydney you can certainly do that. They even have a map. But this is in an area where you can probably just pick a cab up off the street. I expect Uber is cheaper though.

The ambulance services are a triage layer in the emergency intake system. They can route to different hospitals or even buffer the incoming demand for a time if required.

In many of the crises in the canadian system, ambulance operators were tied up for hours not able to pass on their patients to overwhelmed emergency wards. They would sit with the patient in the waiting room until the emergency ward staff would intake the patient. Which meant that there weren't ambulances available. Another example of a centrally controlled system working at it's optimum. The emergency wards had no where to move their patients, since the hospitals didn't have enough beds.

Unless you are talking about unusual situations involving some high casualty disaster, I am calling BS on this.

Question: Why wouldn't insurance companies offer reimbursement of uber/taxi cost plus $50? Enough of an incentive for the patient to save the $1000 when reasonable but hopefully not so much that they put their lives in danger.

Question2: Why does an ambulance ride cost $1000? It certainly isn't direct costs of the driver/paramedics salaries.

Insurance either hasn't caught up, or they don't want the added risks.

An ambulance cost or charge is not the same as the reimbursement. Most third parties have pre-negotiated rates typically lower than the charge. Also many very expensive rides go unpaid. So they will do their best to get higher reimbursements, even if the price they ask is outrageous.

So basically the program is ask for an insane price...every now and then the guy you're bringing to the hospital might be a visiting Saudi prince or someone like that who will just write the absurd check. The real price comes after endless negotiation either with the insurance company or after the ambulance companies bill collector hounds the patient. It kind of feels like we have a market that's basically akin to a Middle Eastern rug market except there are no actual locals who know/get the normal price and we are all tourists.

Its free money from the taxpayer or some big insurance company so who cares?

And of course, the paramedics (often from firehouses...so these aren't private firms) manage to make any old ailment need an ambulance.

A chilling tale of things to come in America.

As the article points out, Uber may increase the total cost of the health incident. Ambulances go to the closest hospital, Uber goes to the hospital the patient chooses, which may be better and more expensive.

Many people are on plans that have pre-negotiated rates, and that will tend to mitigate any difference in costs.

So much of spending in and soon after the ER experience, it is the doc and their assessment and plan that will remain a major factor in overall costs. Whether a 'better' hospital or not.

My stepson did this.

He was on a medication that was giving him some weird withdrawl issues.

He first took an ambulance: $1500 of course.

Then he had it happen again...and took Uber.

I have had intestinal bleeding and had to go to the hospital 3 times

First time, I called Ambulance, got charged $800

Next 2 times called Uber, got charged $15, gave $5 tip , total $20
reached hospital just as fast

I would not call an ambulance, unless I was actually dying or heart attack, stroke
or severe bleeding etc, that needed first aid before reaching hospital ER

I was grateful for Uber and urgent care clinics--and Google for finding an appropriate and nearby clinic--when I fell flat on my face on an Atlanta sidewalk and needed to have my lip stitched up. An emergency room and an ambulance would have been inferior and much more expensive.

I was grateful for Uber and urgent care clinics--and Google for finding an appropriate and nearby clinic--when I fell flat on my face on an Atlanta sidewalk and needed to have my lip stitched up. An emergency room and an ambulance would have been inferior an much more expensive. Either way, I was paying out-of-pocket since my insurance has a high deductible.

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