The Determinants of Public versus Private Provision of Emergency Medical Services
- Presenter:
Chair: Frank Sloan; Discussant: Judith A. Shinogle Tue June 6, 2006 15:30-17:00 Room 326
The value that Americans place on Emergency Medical Services (EMS) has increased due in part to its improved capacity to respond to, stabilize and transport trauma patients, such as from myocardial infarction, car crashes or incidents of violence. The increase is due as well to the role these services play in saving lives and limiting casualties after large-scale catastrophic events, such as terrorist attacks or natural disasters. The viability and success of EMS hinges on infrastructure and flexibility. Municipalities delegate authority to emergency resources by awarding a contract to either governmental entities (e.g. fire districts) or to private ambulance service providers. In awarding such contracts, local governments consider not only costs of deploying existing municipal infrastructure, but also incentives for persistent implementation of novel technologies and fresh ideas. Economists’ views are controversial on the choices government should make between inhouse provision and contracting out. In order to analyze the organizational structure and the economics of emergency medical services, the paper advances a theoretical model drawing on spatial economics and scope of government ownership theory. To test our theoretical predictions, we study the empirical relationship between the organizational structure of EMS, local market and demographic characteristics, and system performance. To do so, we analyze a cross-section of the 200 largest US cities, combining data on EMS providers from the Journal of Emergency Medical Services (JEMS) with data from the National Fire Department Census, the Bureau of Labor Statistics (BLS), the FBI Uniform Crime Reporting (UCR), and the 1990 and 2000 US Census. Approximately 25% of Americans reside in the 200 largest cities. These cities provide a unique laboratory for studying the determinants of different EMS organizational forms, as only half rely solely on in-house provision of EMS, while the other rely either on private or a public-private mix.
