Urban Transport

Uber eats into ambulance usage in the US

Uber eats into ambulance usage in the US
Research suggests some people are turning to Uber rather than calling an ambulance when the situation isn't too serious
Research suggests some people are turning to Uber rather than calling an ambulance when the situation isn't too serious
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Research suggests some people are turning to Uber rather than calling an ambulance when the situation isn't too serious
Research suggests some people are turning to Uber rather than calling an ambulance when the situation isn't too serious

Without the proper insurance, a trip in an ambulance can be an expensive affair. A new study carried out by economists at the University of Kansas (UK) suggests that more people are avoiding these costs by turning to Uber when the situation isn't too dire, and that reducing the reliance on ambulances in this way could have its benefits when its comes to medical care.

In its relatively short (and controversial) existence, Uber has firmly established itself in cities all over the world, with more than five billion trips logged across its seven-year history. With more and more people whipping out their phones and summoning those little car-toony icons, UK economist David Slusky and Leon Moskatel from Scripps Mercy Hospital in San Diego started to wonder what kind of impact this was having on ambulance usage across the US.

So the pair investigated ambulance rates in 766 US cities from 43 different states as Uber entered the market between 2013 and 2015. The team found that across the board, taking into account the fact that Uber typically enters markets sporadically over a number of years, it reduced per capita ambulance usage rates by at least seven percent.

"In order to lower health care spending while improving health outcomes, people can use the least-skilled professional who is still qualified," says David Slusky. "It's the same in the provider space, you don't need a neurosurgeon to diagnose strep throat. Many patients don't need something that can break traffic laws and don't need something staffed by paramedics with a bunch of fancy equipment."

The researchers did consider the possibility that the presence of Uber in a city could reduce the number of ambulance trips by reducing the prevalence of crashes, drunk drivers, or both. They say that the evidence remains unclear on this front, and that the more likely reason is that people are taking up the more cost-effective route to the emergency ward.

While people obviously should err on the side of caution when it comes to emergency situations, the researchers say lessening the reliance on ambulances could have a number of benefits. It can reduce the cost for users and insurance companies and therefore lessen the cost of medical care overall, but also reduce wait times for people that really do need ambulances. They even suggest insurance companies could encourage patients to take Ubers where appropriate with gift vouchers, or educate them about other transport options.

"Given that even a reduction of a few minutes can drastically improve survival rates for serious conditions, this could be associated with a substantial welfare improvement," the team writes.

A paper describing the research is available online here.

Source: University of Kansas

As an Uber driver, I have twice rushed to the ER. Once for a soon 2B Mom and Dad. LoL, he and I were a mess. Mom, cool as a cucumber. And once for a woman in obvious distress.
I was looking forward to my first gonna be a baby, run. Now, not so much.
I think we should be encouraged to get CPR and first aid training.
But all the legal stuff.....
I don't think the author knows if you knew this, but 5% of the U.S. population accounts for 50% of the total GDP for healthcare dollars spent in the United States (https://meps.ahrq.gov/data_files/publications/st497/stat497.pdf) except in Camden, NJ where 3% of the population accounts for 50% of the dollars spent. A 7% reduction in EMS transport by Uber would point to a whole host of assumptions...specifically, could we achieve greater cost savings if those patients were transported to lower acuity centers of care, free-standing outpatient centers, clinics, even doctors offices, where care is provided in a more economical manner? If you can be transported by Uber (or UberX) are you truly sick enough for the emergency department?
I digress. The paper (http://www2.ku.edu/~kuwpaper/2017Papers/201708.pdf) is flawed for the following reasons:
I do not see a comparison in your summary paper of ED usage. To support your premise that Uber has contributed to a decrease in utilization of EMS by members of the public, ED usage would have had to remain the same or should have increased for the time period you decided to examine. If your statement is that people are utilizing Uber instead of an ambulance to seek treatment and access the emergency department (ED) rates of ED utilization would have had to remain the same. Uber is taking those people somewhere. If ED utilization remained the same or even increased, well then bravo Uber!
If ED utilization declined, did those 'Uber patients' go somewhere else for treatment? Was there a corresponding reduction in healthcare costs overall?
Perhaps you did this comparison, maybe you just failed to include it into your summary.
You see if Charles Courtemanche is correct in his paper 'The Affordable Care Act and Ambulance Response Times', ED utilization is directly related to accessing EMS. If you substitute Uber for an ambulance, rates of ED use should remain the same.
Which brings me to my second point. It does not appear that your data is age-adjusted. Older patients have higher degrees of ED utilization and consequently EMS use (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244125/ and https://www.ncbi.nlm.nih.gov/pubmed/12751871). In the last 6 months of life, you will utilize 50% of the total health care dollars attributable to an individual for their lifetime. I guess my question is: in the population centers you examined was the age of the population declining, meaning getting younger, or did the average age increase (getting older)?
A younger population would have lower rates of ED utilization, and consequently, a decrease in requests for EMS. An increase in Uber use would be purely happenstance.
During the time frames you analyzed was the population getting older or younger in comparison? Did you age adjust the population for your examination?
A third consideration for ambulance usage variations varies is directly related to the health insurance status of the individual (i.e.; the Oregon Medicaid Expansion). Medicaid coverage and lack of insurance are each independently associated with increased odds of ambulance use, suggesting a disproportionate role for EMS in the care of patients with limited financial resources. EMS in this instance becomes the 'default' healthcare provider.
In your paper you failed to identify if insurance and economic status changed in any of these communities. If more people had increased access to private insurance, the rates of self-pay and Medicaid insured patients went down, then requests for EMS should go down as well (Pitts SR, Niska RW, Xu J, et al. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. 2008 August 6; McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data. 2006;(372):1–29; Burt CW, McCaig LF, Valverde RH. Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006;47(4):317–326; Committee on the Future of Emergency Care in the United States Health Services. Emergency Medical Services at the Crossroads. Washington, DC: Institute of Medicine National Academies Press; 2006; Camasso-Richardson K, Wilde JA, Petrack EM. Medically unnecessary pediatric ambulance transports: a medical taxi service? Acad Emerg Med. 2000;7:1137–1141)
Fourth, the authors of this paper failed to analyze at any length inroads made to provide care and the goals of programs through the implementation of the Affordable Care Act.
For example reductions in ambulance usage in the Sacramento Area could be directly attributable to the start-up of an accountable care organization (ACO) by CalPERS. The CalPERS ACO was awarded an Innovation in Health Care grant from HHS to reduce unnecessary care, improve efficiencies and efficacies in care, improve the quality of care, AND reduce emergency department utilization.
They enrolled over 77,000 people into the program and over the first 4 years reduced costs by over $110 million dollars (https://innovation.cms.gov/Files/x/Health-Care-Innovation-Challenge-Funding-Opportunity-Announcement.pdf).
The ACO in Sacramento was one instance. Johns Hopkins in Baltimore has a program called Hospitals at Home (https://www.johnshopkinssolutions.com/solution/hospital-at-home/), meant to reduce unnecessary trips to the emergency department by patients post hospital discharge. Sutter Health created the 'Street Nurse' program in Oakland and Sacramento (http://www.ourhealthcalifornia.org/blog/article/sacramentos-street-nurse) to perform outreach for patients and reduce unnecessary ED visits. Kaiser has ramped up a similar outpatient program.
A fifth variable is community paramedic programs. Community paramedic programs have significantly reduced emergency department visits in fragile and vulnerable populations (http://www.chcf.org/articles/2016/09/community-paramedics-rescue-people and http://www.chcf.org/publications/2017/01/community-paramedics-team-hospitals). They have significantly reduced requests for EMS, in both the frequent/ultra user population and the post discharge populations.
While the Uber supposition sounds sexy they have not addressed the underlying variables nor have you identified any of these programs meant to reduce ED usage. You have made a spurious correlation between Uber and EMS, without a valid comparison of emergency department usage to support your hypothesis and you have totally ignored the impact of outside programs on reducing requests for EMS and improving care. Your statement 'Did UberX Reduce Ambulance Volume?' is specious at best.