CBC’s Marketplace has raised an interesting discussion on the cost of ambulance services in Canada.
In an episode which aired on Friday, February 6th, Marketplace found a wide disparity in ambulance charges among the provinces. You can see more here:
One young family were hit with $7,000 in ambulance costs for rushing their young daughter to hospital. Those were costs the family couldn’t afford, so for several medical emergencies they had to rush their daughter to hospital in their car. The mother recounts watching her daughter turn blue in the car. The financial stress was so great they moved provinces where ambulance costs were lower. An elderly man was hit with over $5,000 in ambulance bills for his dying wife. He’s on a limited income and can only pay $30 a month towards the bills, which doesn’t cover the monthly interest charges.
This week a Halifax woman, rushing a woman in labour to hospital, was involved in an accident at the Armdale Rotary. News reports said police issued her a $176.45 ticket for not yielding right of way and causing an accident. There was no consideration given for the extraordinary circumstances of getting a woman giving birth to hospital. We don’t know if this was a choice based on cost or expediency, but we need to look at whether charging for emergency services force people to make decisions which can be even more costly.
We are told with a medial emergency to call 9-1-1, but now one ever talks about the costs. How many people, who have thought of those costs, are forced by economic circumstances to make decisions which place themselves, those they love and others in danger?
Appearing on Marketplace, Chris Hood of the Paramedics’ Association of Canada asked why ambulance fees aren’t part of universal health care coverage? He said we don’t pay to have a police officer come to our home when someone is trying to break in, we don’t pay for the fire department to come put out a fire, so why should there be an additional fee for an ambulance?
That’s a fair question for every health minister to explain.
A New Brunswick cabinet minister said without a fee ambulances would be used like taxis. But they are now. And the people abusing them are health authorities who think nothing of calling an ambulance to transport someone who is merely mobility-challenged between facilities or for a non-emergency treatment. Because someone is in a wheelchair which can’t be accommodated in a regular car is no reason to call in an ambulance. As I wrote in 2010, my community has a paratransit service. A four-kilometre round-trip between a long-term care facility and the regional hospital cost $268 in an ambulance and $13 using the paratransit service. That’s a perfectly acceptable service for a non-emergency, for times when the patient is going for a check-up or non-invasive treatment or to see a specialist. Having such a system frees up the ambulance and paramedics for actual emergencies. Using the system as we do for these non-emergencies does downgrade it to a glorified taxi service.
And speaking of ambulances, in December 2009 an 81-year-old man had a heart attack across the street from Soldiers Memorial Hospital in Middleton. His 83-year-old wife ran into the hospital ER for help and was told to call 9-1-1 or carry him in herself. Would they have been billed for that? The incident made national news. In response, Annapolis Valley District Health Authority, which is responsible for Soldiers’ Memorial as well as Valley Regional hospitals, promised to develop a policy about medical emergencies which happen on the hospital doorstep – doorstep using the sense of this event happening close to, but not in the ER. Shortly after that at another hospital someone who had an incident mere metres from the ER doorway was told by staff to call 9-1-1. The idea that minutes count doesn’t seem to register.
As we move to a unified health system, what is the policy on extending care to those who require care, but who while on the property aren’t yet in the building?
This leads us to the situation at Capital Health. As I wrote about in April 2012, the province has a target to off-load patients from ambulances in 20 minutes 90% of the time. In their fourth quarter report for 2010-2011 Capital Health admitted it took them 133 minutes to off-loading patient. That was up from the 114 minutes it took in the previous quarter. Capital Health promised then Health Minister MacDonald to improve performance by 10% per quarter, which gave them until September 2015 to meet the health department’s requirement. Are they on track to meet their deadline?
And, what happens to patients whose condition deteriorates while waiting in an ambulance in the hospital parking lot for a doctor to see them? They can’t really call 9-1-1, that would just be more delay.
Marketplace will be following this issue. If you have horror stories about ambulance service, now is the time to share them when the pressure is on the ministries and executives to perform. Make their failures part of the permanent record so it can be fixed.