Administration and Leadership, Columns

Is Your EMS Service Privatization Proof?

If you are a public EMS agency, such as an ambulance district or fire department, how well is your operation protected from being privatized? While privatization is probably not a topic you think about on a daily basis, it’s one you should be prepared to face, should the issue ever be raised in your community about turning EMS operations over to a private ambulance service.

In some areas of the country privatization is present in many different forms. From garbage collection to prisons to toll roads, city and county governments have moved services that are traditionally government-delivered services to private industry. While there isn’t a constant rush to embrace this idea with ambulance service delivery, there are some examples where a public service, either a community ambulance or fire service ambulance delivery, was replaced with a private ambulance company. The 2006 JEMS 200-City Survey (PDF) reports an almost equal split between public and private providers based on the number of responses.

Has the issue of privatization ever been mentioned, or even whispered in your community? Would you know ahead of time if your government officials were entertaining the possibility of replacing your agency with a private ambulance service? Have you developed your service delivery to make it extremely hard for any politician with an agenda to attempt to replace you?

I want to share with you some arguments often used to promote privatization or to keep EMS delivery by private providers. But, you should develop specific arguments/explanations that are relevant to your community.

Privatization proponents like to tout that privatization allows for competition and gives the citizens in the community more choices and better services. If that was truly a great model, then the clear majority of cities and counties would be using it, but that isn’t always the case. In the delivery of public safety, more choices does not always equate to better services. EMS is not the same as grocery shopping, where you look for the cheapest prices. When was the last time you saw a private law enforcement company bid to compete with the local police department for police protection? Why should the ambulance service be any different?

Privatization of ambulance services keeps taxes under control and provides the least expensive model for service delivery. This point is often made in the case of fire and ambulance districts/departments that receive funding from some form of taxes, usually annual personal property taxes that charge users a fee for transport. The private services don t receive any direct funding from taxes collected, but some do receive a subsidy from the community or county in order to help cover the costs of service delivery. When looking for medical care, do you shop for the least expensive hospital or physician to provide for you, or do you use other standards?

Private providers can deliver better performance. To date, no performance verses cost comparison studies have shown private providers save more lives than public safety delivery models because of their service delivery methods. There are fewer private service delivery models than public safety models. In the case of public-private partnerships, the private entity is able to meet response times by having public-safety first responders arrive on the scene first.

Private EMS providers provide high performance and cost less than public safety delivery. There is no current performance comparison report between public and private services to validate this claim. As to the claim of costing less, many private providers require a subsidy from the government entity to provide a pre-determined level of service. The lower cost is usually found in the quantity of resources and level of pay to employees.

In addition, these private companies usually don’t pay sales tax (that helps provide for the infrastructure of the community). In most cases, public safety agencies provide more than just a transport service. In many cases, public education and injury prevention or the role of a firefighter is a part of the mission to help protect the citizens.

Private ambulance services are better equipped. No measure determines the level of equipment of private providers verses public providers. Many ambulance services are required to either meet a state or national standard for basic equipment carried on ambulances. The resources available and the medical direction of a service will usually determine the quality and quantity of equipment.

Using a private service will provide quicker response times and higher quality service than the use of public safety agencies. Having ambulances posted in certain locations with crews seated and ready to respond at a moment s notice can seem to provide for a somewhat fast time to respond. However, usually fewer units are on the street, creating a much longer time to arrive on the scene than ambulances stationed in the community. The measure of quality is somewhat subjective given the variability of the levels of service delivery in the two models.

I recognize that in some communities the decision to use private providers is the best model for that community. However, I have to make a single point that there is no law (that I am aware of) that will require a private company to continue to provide service when a business decision is made to no longer exist as a company. That means that at any time, any place, a private provider can make a phone call or send a letter informing the elected officials in that city or county that as of a certain date they will no longer be providing ambulance service.

A public safety agency doesn’t have that option. Even when an agency suffers from poor financial resources, it still must provide a level of emergency service to the citizens of the community.

The role of an EMS manager is to be pro-active and look long-term at issues that affect your service delivery. Quality emergency medical services should be the goal of every manager, regardless of the method of service delivery. My hope is that this article will have at least raised your awareness of a few of the potential arguments for privatization in your community.