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KU Economist Says Uber May Be Driving Down Use Of Costly Ambulances

Alex Smith
KCUR 89.3

Ambulances are often considered a prime example of the excessively high cost of medical care in the United States. One ride can cost more than a trip from Kansas City to Hawaii.

But David Slusky, an assistant professor of economics at the University of Kansas, thinks he may have found something surprising that’s reducing ambulance use: the ride-hailing company Uber.

KCUR’s Alex Smith talked with Slusky about his recent research paper on the topic, which he coauthored with Leon Moskatel, an internist at Scripps Mercy Hospital in San Diego.

Why should we be trying to curb the use of ambulances?

In any healthcare system, regardless of how things are paid for, you have a limited number of ambulances, and the more kinds of calls they take, the longer they take to get to other calls and the possibility that they might not get to someone in time.

Additionally, in our system, where a lot of the upfront costs of health insurance are passed along to consumers for the first couple thousand dollars, an ambulance can be a very expensive proposition. And so there, consumers also have an incentive to not take an ambulance if it’s not something they really need because they can avoid a multi-thousand dollar bill.

So how did you look at the effect Uber has on ambulance use?

There’s a company called Nemsis which aggregates ambulance volume data across the United States. We were able to work with them. And so we gathered from Uber’s website information about when they entered each city. We matched that up with the ambulance data. And then we could look at—relative to before Uber entered and after—the change in the per-capita ambulance volume for each city.

And what did you find out?

We found that ambulance volume declines by about 7 percent when Uber enters the market.

Why do you think that is?

I think that people know they have high-deductible health insurance plans or have no insurance. People know that insurance is going to cost them a lot of money, and if they don’t think they really need it, they know that an Uber’s going to be a lot cheaper.

I’ve heard anecdotally that Uber is creating a decrease in the amount of drinking and driving that’s taking place in cities. Is there anything to that?

So there are a variety of studies to that. And the conclusions are actually very mixed. So we’ve thought about that as a possible other mechanism. That’s not something we can test with this particular data set. But I will say that there are some papers out there that have found no impact on market entry in drunk driving and some that have found substantial effects, so we’re not really sure what the result is there. And so we’ve been hesitant to draw conclusions from that to our paper.

If I were an Uber driver and I was picking up someone who asked to go to an emergency room, I think I might be a little bit worried: Is this person going to have a heart attack or a stroke or something like that? Do you think it’s fair for people who are in an emergency to use Uber?

Given Uber’s current terms and conditions, I don’t think they are doing anything against their agreement with the company. I’ve never been an Uber driver, so I’m not exactly sure what the reasons and situations are when an Uber driver can refuse a passenger.

I will say I think there’s a big market here for the emergency medical services to get into this space, right? They already have triage resources when you get to the emergency room to say, “Have a seat” and you wait for several hours, versus “Don’t have a seat, come straight in.

That triage facility could be pushed upstream to when you call 911. I was speaking with an emergency medicine provider earlier today who said that in most places, if you call 911, they have to send you an ambulance. And I asked him, “Do you see a world where that doesn’t have to be the case?” And he does. He said that could be possible.

So we could imagine a situation where you call 911. 911 video chats with you, takes a look at you, and then potentially sends you a less sophisticated vehicle that’s not a mobile emergency room that can disobey traffic laws. But (it) sends you a regular driver who might be an EMT with the proper liability insurance, and that person takes you to the emergency room, as opposed to a full-fledged ambulance.

David Slusky, thank you for your time.

Thank you so much.  

Alex Smith is a health reporter for KCUR. You can reach him on Twitter @AlexSmithKCUR

As a health care reporter, I aim to empower my audience to take steps to improve health care and make informed decisions as consumers and voters. I tell human stories augmented with research and data to explain how our health care system works and sometimes fails us. Email me at alexs@kcur.org.
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