Uber is Cutting into US Ambulance Volume


Patients are prioritizing their health care costs when considering transportation to the emergency department.

David J.G. Slusky

David J.G. Slusky, PhD

Ambulance usage rates are on the decline, and researchers believe that’s due to Uber.

A study has found that the implementation of ride-sharing service in US cities correlates with decreases in per-capita ambulance usage rate of at least 7%. The trend, which researchers believe would include other ride-sharing services such as Lyft, may be in part due to high costs for ambulatory services.

Author David J.G. Slusky, PhD, Assistant Professor of Economics at the University of Kansas, told MD Magazine that patients are more responsible for their health care decisions than they once were, as costs continue to rise.

“People bear much more of the upfront of the cost of their care, and that influences this,” Slusky said.

Using Uber’s website to track announced debuts of the service in different areas, researchers compared its correlation to ambulance usage rates and response volume with the National EMS Information System (NEMSIS) database. Uber was considered present in a region if it operated there for a full quarter of a market year.

At the time of the data collection (through December 2015), the ride sharing service was present in 43 states and Washington, DC.

Researchers submitted Uber entry dates by state and city to NEMSIS, which then merged its aggregated ambulance volume and ambulance rates with the Uber data. The results were then encrypted to ensure individual states and cities could not be identified, and returned to researchers.

In the analysis of 797 city-state groups to receive Uber services between Q3, 2013 and Q4, 2015, researchers found there was at least a 7% (95% CI, 1.21-16.74) decrease in ambulance rates following Uber’s entry.

As a result, researchers believe ambulatory wait times for dire medical emergencies likely reduced in these areas, which could be associated with a “substantial welfare improvement.”

“That $1,000, $2,000 bill represents a larger part on the patient,” Slusky said. “We’ve all been in situation when we get to ER room and they have you wait for 2 to 3 hours. Getting there as fast as possible, in a sophisticated manner, is not as important when you know you’ll be waiting.”

Slusky argued there is not as much heterogeneity in emergency care as there could be. Patients meet with psychiatrists for depression, an internist for physicals, and specialists for conditions. But there is no differentiation for ambulatory care.

“Even if you’re not in a position to drive yourself, you might not need an ambulance and all the resources it has,” Slusky said.

Patients have also become more involved in the process of their care, Leonardo Huertas, MD, told MD Magazine. The Chairman of the Huntington Hospital Emergency Department in Manhasset, NY, said patient expectations have changed in the internet era. It could influence their decision to choose an Uber ride over an ambulance.

“This is the internet-Google generation, and most people will search their symptoms and diagnose themselves before they come in,” Huertas said. “It’s a different patient than what we were seeing 25, 30 years ago.”

Stationed in a suburban region, Huertas said Huntington Hospital has not had as much experience with patients utilizing ride-sharing services. That said, the facility has made significant improvements in recent years to address the delayed emergency department wait-time Slusky made reference to.

Through an upfront intake model, the hospital has prioritized treatment first towards patients who have arrived in ambulances. The mean 42-minute wait per emergency department patient in 2015 has reduced to about 20 minutes now, Huertas said, effectively saving hospital workers about 20,000 hours of work annually.

Future care may not even necessitate a patient having to chose between an Uber or an ambulance. Emergency department telehealth is advancing to eventually allow physicians to connect remotely with patients, and advise them on how to proceed with care in a situation, Huertas said.

“It’s something expected in the future,” Huertas said. “You’ll be able to dial your doc, anytime.”

The study could benefit from an overall look at emergency care and response-time data, among various other directions, Susky said. The researchers are currently exploring data sets for expanded analysis.

Though Uber is only years removed from start-up status, ride sharing services have already embedded themselves in a market they never intended. Sometimes, patients just need a ride.

“Uber is immediate and reliable in a way that we haven’t had in certain parts of this country,” Slusky said.

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