Why aren’t ambulances included in universal care coverage?

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:

http://www.cbc.ca/marketplace/episodes/2014-2015/ambulance-fees-no-free-ride

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.

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6 Responses to Why aren’t ambulances included in universal care coverage?

  1. ghjkl says:

    Speaking of ambulance services, you comnent on the move to a unified health authority (and the IWK) and speak about unified policies across the unified health authority. I would like to report a recent “anecdote”. my wife had had a very devastating cancer which was beyond surgery, she was put on palliative chemo and at some point the chemo regimen was no more effective. We discussed with the medical oncologist and found that there was a new protocol (working through a complete different pathway than the previous one) which was possible. Unfortunately, one of the two drugs involved was “not covered”. The oncologist discussed with the company making and marketing the drug and the company was willing to provide it for free (there has been a few cases reported of this new regimen working for some times after the first one failed). But the drug would not obtained through the CDHA pharmacy but directly from the company, and for CDHA this qualified the drug as “privately” obtained. Now here is the point, there was a committee made between CDAH and Cape Breton Health Authority do write a policy regarding the administration whitin their respective hospitals of such drugs “privately” purchased. CBHA representatives left this committee becaus the decision made was to forbid the administration of such medications within CDHA facilities, when on the opposite CDHA was willing to do so. From our perspective as patient and caregiver the CDHA decision was very detrimental, the IV administration of the drug was only possible either by going to CB or by using a private injection facility in HRM. To use the private facility would cost the same amount of money to MSI than having the injection made at the VG cancer treatment center on the 11th floor, but it would save CDHA the cost of handling the drug… So when NS will move to a unified DHA what would be the policies enforced? Policies approuved by bean counters or policies placing the patients truly in the center of the care strategy.

  2. A reader has left a reply to this post, however, I need a short clarification – merely a typo or missed word, I think – but can’t contact that poster because the email address doesn’t work. I do keep contributor’s identities confidential, but have to be able to get corrections and clarifications before I publish anything. Thanks.

  3. pierre says:

    “they” refers to my name and email. And I disagree with the statement that France has a stellar healthcare being myself a patient and a healthcare professional. I mean since the healthcare system has neither guidance nor foreseeing. Despite every measure taken or not take, the deficit has been increasing to a “stellar” level for healthcare and pension plan. France is bankrupted because of this deficit.

    • Yours seems to be the common complaint in western countries, whether their system provides universal-coverage, a public-private system like the UK or a private payment system like the United States. Whatever the style of system, all seem to threaten to bankrupt their host country. Costs seem to rise faster and be the highest in the private pay system. IF you can afford it, the results may be best in that, but in countries as wealthy as ours citizens shouldn’t have to worry about whether they can afford to be ill or require care.

      I think the problem comes squarely back on those who are in charge. If systems fail, if complaints remain consistent, if outcomes stagnate and staff are dissatisfied then why do we continue to hire health care managers from the same small pool with the same shared background?

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