News Local governments start charging for frivolous ambulance calls

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Three hospitals in Maysusaka City, Mie Prefecture , will start charging emergency care patients 7,700 JPY (about USD 52) for ambulance rides in June as "elective medical expenses" if they end up not staying in the hospital overnight, the municipal government announced last Monday. The initiative intends to promote responsible ambulance usage within the community. During a press briefing, Mayor Masato Takegami of Matsusaka clarified, "This doesn't imply, 'Please refrain from contacting an ambulance.' We aim to ensure that individuals don't hesitate to seek medical assistance when experiencing pain."

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Matsusaka Fire Department ambulance is seen in Matsusaka, Mie Prefecture (Mainichi)

The three core hospitals in the city -- Saiseikai Matsusaka General Hospital, Matsusaka Chuo General Hospital and Matsusaka Municipal Hospital -- are in charge of treating patients in severe condition who require hospital stays or surgeries in the area covered by the Matsusaka Fire Department, which consists of the city of Matsusaka and the towns of Taki and Meiwa. According to the Matsusaka Municipal Government, exceptions for ambulance charges include those involved in traffic accidents, public servants' injuries in the line of duty, emergency transportation with a referral letter from the family doctor, and those covered by publicly funded health care. Furthermore, the doctor in charge of the patient will make the final decision whether to charge for the ambulance ride even when the patient doesn't stay at the hospital overnight. The Matsusaka Fire Department dispatched ambulances over 15,000 times in 2018. Fearing lives could be endangered if ambulance call numbers continued to rise, straining emergency medical services, local medical associations and other parties launched a liaison group in December 2021 to discuss possible countermeasures. They also looked over the planned work-style reform for doctors slated to take effect in April 2024 and aimed at reducing doctors' overtime.


Despite the liaison group's efforts to encourage residents to use ambulance services exclusively for emergencies and to consult their family doctors for other health concerns, the number of ambulance dispatches rose, reaching 15,539 in 2022. Compared to fire departments of similar size across Japan, the Matsusaka Fire Department had the highest ambulance call rate per 10,000 people. Remarkably, 56.6% of these cases were categorized as minor and did not necessitate hospitalization. Furthermore, the liaison group surveyed the city's three core hospitals between April and June 2022, revealing that more than half of the patients who made emergency calls did not require hospital stays.


 
The average cost of an ambulance ride without insurance in the United States can range from a few hundred dollars to over a thousand dollars. The average base rate might range from $400 to $1,200 or more, while mileage can cost anywhere from $10 to $30 per mile, and these are ballpark figures and can vary widely. The list price of an ambulance ride rose 22% to more than $1,277 between 2017 and 2020. The average charge for an ALS ambulance ride is $1,277 and BLS is $940. The average ambulance ride ranges from $940 to $1,277 depending on the level of care needed. 79% of patients who took a ground ambulance could be on the hook for an average fee of $450 after their insurance.
 
The average cost of an ambulance ride without insurance in the United States can range from a few hundred dollars to over a thousand dollars.
Informal/ancedotal reports from some people I know in the US--prices seem to start at $2,000.

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I suppose Matsusaka will revisit this in a year or so to see how/whether it's working.
 
I remember that around 2010, each ambulance ride in Tokyo amounted to (back then) ~JPY 45,000. Not sure how much it is nowadays.
 
I had an ambulance ride in Tokyo around 1995 after a bicycle accident. I don't remember getting charged for it.
 
Of course not, it's usually covered by health insurance. :)
 
Starting in December, large hospitals in Ibaraki Prefecture will charge patients a minimum fee of 7,700 yen (about $50) for nonurgent ambulance use. The prefectural government announced this "selective treatment fee" system on 26 July to encourage proper ambulance usage. While similar systems exist in some municipalities, such as Matsusaka in Mie Prefecture, this is the first time it will be implemented at the prefectural level.


The Ibaraki government will work with large hospitals with 200 or more beds for general patients and other parties to establish guidelines. Each hospital will determine the urgency of the ambulance requests. At least 23 of the prefecture's 25 large hospitals have indicated willingness to participate. Major hospitals in the country collect selective treatment fees from first-time patients without referral letters based on the National Health Insurance Act to prevent a concentration of patients. Simultaneously, many large hospitals do not charge for ambulance rides because such situations are supposed to be "highly urgent." Of the approximately 130,000 emergency callouts in Ibaraki Prefecture in 2022, about 60,000 were minor cases that did not require hospitalization. On the other hand, the number of instances in which officials couldn't find hospitals to accommodate emergency patients reached a preliminary figure of 8,470 in 2023, representing an increase of more than 2.5 times over the past five years. The prefecture hopes the system review will reduce the strain on emergency medical care.


 
Out in my parents area, rural Wisconsin in the US, where the hospitals can be around 45 minutes away, the cost of the ambulance ride is around $5,000. Moving by helicopter from one of those rural hospitals to a major hospital (serious situation that the rural hospital can't handle) in the Twin Cities (Minnesota) is around $30,000 USD.

Insurance will usually cover the largest share of that but the bill you get stuck with is still scary high.
 
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