More Patients Pass on Ambulance

[VentMedic]

http://www.emsresponder.com/article/articl...p;siteSection=1

As Costs Rise, More Patients Pass on Ambulance

Laura McVicker

The Columbian, Vancouver, Wash.

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Dec. 15--It doesn't matter the circumstances -- car crashes or chronic illnesses -- Scott Koehler often hears the same plea from patients: "I can't afford to go to the hospital."

Some patients would rather drive themselves to the hospital, hitch a ride from family or friends or skip medical attention to avoid ambulance costs, said Koehler, East County Fire and Rescue's chief.

The average tab for an ambulance ride in Clark County is about $750, but can escalate to $1,000, depending on mileage and other factors. Insurance can cover most, if not all, of the costs but leaves the uninsured with a hefty bill.

Refusing ambulance rides is an ongoing issue for all emergency personnel, both locally and nationally. And as more people tighten their belts during the economic downturn, some responders expect that number to grow.

"More folks tend to be concerned during times when the economy's bad," Koehler said. "I think that's a function of people holding their money tighter."

So far, local statistics don't show a decline in the number of transports. At 25,000 transports so far this year, American Medical Response officials say they are actually about 3 percent higher than normal compared with the last several years. They attribute that hike to population growth and an aging population.

Still, some emergency responders said, anecdotally, it seems their transports are down the last few months.

"That might be because people are not even instituting the 911 system because of the fear of not affording it," said Rob McDonald, Clark County's American Medical Response operations supervisor.

And there are other reasons people refuse ambulance rides: Some simply don't feel sick or hurt enough to go to the hospital. This sometimes happens after car accidents, for example, when a patient doesn't have visible wounds. But after a few days, these patients find they require treatment for internal injuries.

Still, a large percentage of the people who refuse ambulance rides do so because of ambulance and hospital costs.

Only getting worse

The health care crisis has compounded the problem in the last decade, said Vancouver Fire Capt. Dave Seabrook. Many patients avoid seeing a doctor until their illness is so severe they call 911, or they use the hospital's emergency department as primary care.

"It's just harder for people to afford health care - that's something I've noticed for at least the last five to 10 years," Seabrook said. "And when you're without health care, you tend to avoid care."

That's a national trend. Since 2001, the ambulance industry nationwide has been hit with greater debt because more patients are uninsured or unable to budget the growing health care premiums, said Tristan North, senior vice president for government affairs for the American Ambulance Association.

"It's something that the industry has had to deal with for a number of years," North said.

Some emergency responders, such as Seabrook, fear the problem will worsen if the economy continues to buckle.

"I think with the economy and specifically with the unemployment rates, it can only get worse," he said.

Refusing rides

There's little that emergency responders can do once a patient refuses a ride to the hospital -- besides directing them to sign a liability waiver.

"You can't kidnap somebody in this country," Koehler said. "Even if it would be for their best interest."

Leaving patients, obviously, raises concern for area paramedics. A Clark County patient once declined transport because of costs and went into cardiac arrest on the way to the hospital, Koehler remembers. The patient died.

In just the last month, Seabrook handled two calls in which two patients refused treatment during a critical situation.

One patient suffered a seizure for unknown medical reasons, and when urged by paramedics to seek examination, refused. The patient had insurance but was still concerned about costs.

Seabrook remembers another patient suffered a reaction in the middle of the night. He declined a transport because he didn't have insurance.

In these types of cases, emergency responders say they go through the same routine: They urge patients to still seek medical care. If they don't have insurance, paramedics point them to free clinics.

Also, they chat with them about how they plan to get to a clinic, and warn them about the dangers of delaying treatment or driving themselves to hospitals or clinics.

"Going in a private car is OK," Koehler said. "But if you're short of breath, we don't want to take you off oxygen."

McDonald sees ambulance-ride refusals as crippling paramedics from doing their job.

"When people institute the 911 system, it's typically an emergency," he said. "We want to make sure they get that gold standard of care."

[Arctickat]

Wow, $750 bucks for a transport in the county? We're less than 1/3 that...in fact, I think I'll go start a new thread on this.