I guess in the US the incentive of the hospital is just to bill you as much as possible so it makes things different. In many places the incentives of the hospital are just to keep you in good health and do not overspend their budget ...
There are enough ambulances to cover legitimate needs. Why then waste money by using ambulances to transport people who would be just fine in a Lyft? That money could be better spent on actual patient care. No matter how much money you're willing to spend on healthcare, using it efficiently is always better than wasting it.
> what kind of ambulances should be used should be up to medical professionals, not yourself
Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.
Medical professionals who are under orders to ignore their medical judgement and always treat patients as lightly as possible.
Also, deciding for yourself not to take an ambulance is one thing (even if questionable). Being forbidden by your employer to call 911 is something completely different.
TFA says Tesla managers made a policy to not involve emergency services. They are not entitled to make either a policy or a decision in this regard.
In other countries making such a policy is flat out illegal, telling subordinates to not involve emergency services is illegal and following such directions from superiors is illegal as well.
then again one time I helped an old lady when she biked home drunk, fell over and got a concussion and they sent an ambulance.
However in my experience the incentive of the hospital in the U.S is to bill you as much as possible.
And it's worth nothing that this is very much how non-profits operate too. Without making any claims of efficiency there is a wink wink nudge nudge in the US system that overbilling wealthy and insured patients is how we cover costs for patients who cannot afford it.
Horrible cost on the first glance, but if you actually talk to doctors (my fiancee is one), you realize most of the system is under constant overload. If they have emergency call, it can be (and often is) something trivial, when taking a cab for 5% of the costs would be more appropriate. But you have tons of crazy people (not crazy enough to be in asylum, but enough to wreak havoc on everything and everybody around them) and hypochondriacs. Polytoxicomans that effectively can't be helped.
We're not talking about a drive by a specific vehicle, but locking of 2 highly trained professionals that can't be used for any other emergency, with vehicle full of life-saving equipment. Which can easily mean another ambulance has to come from afar if needed, which can be fatal/debilitating in number of cases.
So its not about US as much, its about making system effective, because resources (people, equipment, ambulances) are scarce and you need to prioritize, or people will die. These things can and should be improved, but until they are, doctors and everybody else need to work with what they have.
This is not true for the entire country. Emergency services are usually organized on a local level.
For example: In the city of Zurich emergency services are run by the city (which also serves 17 additional communities). It's very much a publicly owned and operated enterprise.
In addition there are private services, but on a very limited manner. For example: The orthodox jewish community runs its own ambulance service.
Details, in German, can be found here : https://www.stadt-zuerich.ch/pd/de/index/schutz_u_rettung_zu...
https://www.nremt.org/rwd/public/data/maps
(the circle thing that should be a table)
There are two "halves" to EMS in the US. One half is 911/scene response, the other half is interfacility transports. It's pretty common for interfacility transport companies to staff most of their rigs with EMTs, since those patients tend to be low acuity, and just need to be moved from one hospital to another.
Companies that do 911 response generally staff their ambulances with an EMT and a paramedic. Paramedic training is several thousand hours of classroom and clinical time.
So while it's true that overall EMS is mostly EMTs, in the area we're discussing (ambulances that respond to 911 calls) paramedics are much more common. Granted, that's only a $3-5/hr difference in most places, so it's not a massive difference in cost.
Actually $500 is cheap. It'd be a no brainer if it were that cheap in the US.
I think 'Ambulance no Ambulance' almost has to be kind of a moral decision, not a cost one: if you don't need it, don't use it because it's a scarce resource that will always be scarce.
There’s a lot of downsides to that when a true emergency isn’t happening.
The US has no problem with ambulance quantities, but why take an expensive taxi ride?
Even if it was 'free', its not really free.
I completely agree that the US medical system is corrupt, https://www.opensecrets.org/lobby/top.php?indexType=s
But you have seemingly no understanding of how insurance works or how deductibles work.
No, this is kind of a naive position.
The OP's comment is to a great extent valid.
Ambulances and their staff are extremely expensive.
Do you think in Brazil, France or Japan money just grows on trees and you can just magically buy more stuff?
Medical systems the world over are failing under understaffing and over demand - and a considerable amount of the demand is small stuff.
There are many people in socialized systems who go to the clinic/hospital with great frequency - any old thing: see the doctor. It's hugely, hugely expensive. In some cases it's merited, and I understand it's a moral dilemma because often you don't know if something is serious ...
But Emergency care in particular is bonkers expensive, even by cost not profit ... and there's no getting around it.
If people need to call an Ambulance, then get one.
But if you don't need one, get in a car and go or have someone drive you.
It doesn't matter what 'system' it's in because everything associated with 'Emerg' is very costly to the system, and it will always be a very scarce resource.
I wouldn't let anyone at my company decide for me though - if I needed one I would call.
Tesla might need a union.
No, but even Brazil can buy more ambulances.
Also in Brazil, you have paramedics that can ride motorcycles and can be sent to the site of an injury first, to stabilize the patient, provide immediate care, and prepare for the arrival of a proper ambulance. Since they are bikes, they can better navigate traffic jams and can get to the site more quickly. If it turns out that an ambulance ride is NOT required, then it can be canceled. There are some paramedics in cars for a similar function, except cars can carry more equipment.
These are trained paramedics who have seen their fair share of injuries. I'd trust them much more than a company health clinic doctor.
There ARE alternatives. Ambulances are a limited resource everywhere, but you can work around the issue.
But then we'd have to (melodramatic pause) raise taxes!
(Audience faints en masse)
Amazing.
And in the wealthiest country in human history, that staffing cost is also the highest in human history.
I’m not totally sure why it’s created such a huge disagreement. Obviously there are some injuries which totally don’t need an ambulance, and some which do, and then a big grey space in the middle where it’s harder to tell. Unfortunately, in some places (like here in the UK), there aren’t the resources to err on the side of caution as much as in other places (by the sounds of some commenters). Being able to have an ambulance arrive within 10 minutes for any situation sounds like a wonderful luxury if you have infinite resources to burn. I personally was impressed they dispatched an ambulance when we delivered our baby at home (on the bedroom floor!). But I also felt a bit like it was a resource that might have been wasted.
There is only one claim, ie. "Ambulance when required". The point of contention is who decides what required means.
Tesla has a perverse cost saving incentive to recommend the cheaper option. The person in shock is no position to make a rational decision. It is medical practitioner's responsibility to put his practice before his employer and decide what is a medically appropriate response. The emergency service has an incentive to be deployed regardless of severity.
The comments section in general, agrees that a severed finger and crushed hand are sufficiently severe injuries to warrant an ambulance.
It seems pretty.obvious to me that lay-managers and CEOs should not be the ones deciding emergency policy. That is what trained practitioners are for and the expectation is that they will hold the org to a certain regulatory safety standard.
And the cheaper option for Tesla would be not to hire a team of full-fledged doctors waiting in a room 365 days/year for taking care of any injured worker.
I remember the “funny” story of the guy who accidentaly stabbed himself in the chest with a nail gun and drove to the hospital thinking “that’s a pretty f*cked up day”
It makes for a nice tale, but those people are real, and for every drama queen going to ER for a papercut there is people in serious condition waiting for a Lyft that decides to drive a better client first or stays stuck in the trafic.
Ambulance drivers are customed to drive fast and ignore any red light; they have accidents also. To expose yourself to an increase in the probability of having a car crash because you had a minor injury, or one that is stable and can not really benefit of the specialised services provided by the ambulance, is stupid. Each case is different and must be treated individually.
As they can't transport people to hospital and they don't carry strong painkillers they're basically useless if you've got, say, a broken arm.
Lol what? It's the job of the state to provide adequate resources (for example, the law in Germany requires that emergency personnel be at your location in 10min tops, on average). Telling people to use an Uber/Lyft/cab due to cost concerns or not enough ambulances being available is bad. Demand proper emergency services funding from your politicians!
Obviously: when all you got is a small cut on your finger, fine, take public transport or whatever. But for a back injury?! No way in hell I'd risk my chance in public transport or taxi.
https://en.wikipedia.org/wiki/Emergency_medical_services_in_...
Forget Uber, you better be able to walk to Canada or something.
Now, the NHS may not charge German patients themselves for an ambulance ride in UK but either quietly deal directly with the German insurance to get the cost back, or eat it entirely because the administrative overhead would cost more than the fees paid by German insurance would actually bring in - while the German ambulance operator might have decided to put the administrative burden on your friend.
tl;dr: international health care insurance/refunds are weird, avoid if possible...
The hospital won't send an ambulance with ER stuff for a guy who don't need it.
In France firemen do a very big chunk of that work with their ambulances.
I assume you're a doctor and able to perform a medical analysis on the accident, so you're fine to go with Lyft.
I better call the emergency service and let them decide what would be the best way to go forward depending on my symptoms/injury.
The point here is that it is preferable to sometimes use resources badly in order to avoid sometimes not at all using the resource when it would be necessary. The point is to not discourage people from calling 911 (or the local equivalent).
If there actually are constrained resources† then, sure, that cultural value should probably be set somewhat differently, but I cannot for the life of me imagine why that should be the case in the US. It’s not necessary to set that value differently. (If it were that would be a real shame for US healthcare and you should demand immediate change from your political representatives.)
—
† I am aware that at some point all resources are constrained. What I’m talking about here is that the system should be designed in such a way that there is spare capacity availible at all times when looking at the maximum number of required ambulances at the same time during, say, the past twelve months.
Medical professionals that they "incentivize" to make a specific decision they like.
> “It was bullying and pressuring to do things people didn’t believe were correct,”
Isn't it the same with ER? People are severely discouraged from using ER for any concern that doesn't require an immediate action. ERs, like ambulances, are services whose time and resources need to be highly available for those who really need them.
There's a conflict right now in Germany, as many people turn to the ERs instead of primary care practitioners or specialized doctors (e.g. urologists), as for ordinary people it's next to impossible to get a timely appointment.
This, again, has the reason that specialized practices reserve the "timely" slots for higher paying privately insured patients, and that the distribution of general practitioners as well as their supply is a bit... mismanaged, leading to either the practices not being open at times when people are not working (in contrast to a 24/7 ER) or horribly overcrowded.
If you as a patient drive yourself to an outpatient cardiology office to get some diagnostics and feel perfectly found but severe blockage is found, the staff will call an ambulance and have you transported to the nearest ED. Even if you are asymptomatic. Fun fact: this will also happen if the ED is within walking distance. There have been cases where an MA was wheeling a seeminly OK patient from a cardiology office to the ED and the patient collapsed in the hallway. That's why it's against protocol.
Yes ambulances are insanely expensive (that's another problem). But availability issues are handled by the 911 dispatcher.
Actually the Lyft is the stupidest idea here, you combine the disadvantages of ambulances with those of personal transport, with none of the pluses