International Survey on Ambulance Services: Alternative Models

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International Survey on Ambulance Services
Alternative Models

• Friday, October 28th, 2005
• The Museum of History
• Hong Kong

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The Lion Rock Institute

• Independent public policy think tank
• Dedicated to researching, generating and
  advocating public policy solutions for a freer
  and more prosperous Hong Kong
• Also involved in education of policy makers and
  the general public
• Importing the worlds best, exporting Hong Kongs
  best practices to the world.
• Three co-founders 6 person Board of Advisors
  from Hong Kong and abroad
• A new type of organisation in Hong Kong and
  growing.

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Todays Objectives

• Generate awareness of alternative models,
  benefits and challenges.
• Launch a discussion of what can be done to bring
  better ambulance service to Hong Kong, among the
  people who know the system best you.
• Raise the bar!

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Could we be doing better?

• Not the drivers, not the funding its the
  system.
• Ambulance Medical Priority Dispatch System? 20
  years behind the USA CUHK AEMAU

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Could we be doing better? (II)

• Labour Disputes over working conditions Im not
  done my lunch!
• Excessive stress levels.
• Cutbacks to funding.

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Could we be doing better? (III)

• 180 of 215 ambulances running (2003).
• Calls expanding 5-7/year.
• Resource allocation Disney over Mui Wo?
• Standards below OECD norms.

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Why Alternative Models?

• Response times Los Angeles 5-8 minutes, Chicago
  4-6 minutes.
• Higher percentage response compliance (normally
  over 95).
• Technology More new technology and newer
  equipment in many alternative model systems.
• Cost savings Stockholm, Benoni (SA), San Mateo,
  Pinellas, Michigan, Ontario, more.
• More savings means more development of people and
  staff. San Mateo increased paramedic staff from
  60 to 220. BFES (SA) runs its own training
  school.

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What Alternative Models?

• USA

2000 Journal of Emergency Medical Services (JEMS)
survey
Co-ops in Canada!
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AM Problems?

• Oversight billing, inexperience by overseers.
• Labour Disputes. (Netherlands retirement)
• Change in government policies leads to confusion.
  (US Medicare and billing)
• Minor, related to administration no evidence of
  decline in quality of service.

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Where?

• Denmark
• Sweden
• Norway
• South Africa
• Philippines
• And many more!

• Canada
• USA
• Belgium
• India
• Botswana
• The Netherlands
• Australia

Soon, Hong Kong will be the alternative!
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AM Volunteer Services

• India Sri Gian Sthal Mandir sabha provides
  ambulance service for widows in Ludhiana, India.
• Pamilya Mo, Lingap Ko Philippine National Red
  Cross and Rizal Commerical Banking Corporation
  ambulance services for OFW.
• Small town America, Canada, and even Hong Kong
  (St. Johns Ambulance pre-hospital care at
  events).

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AMVolunteer - Private - Government

• Dunlip County, North Carolina Volunteer service
  under pressure as people spend more time at work.
  Considering mixing volunteer efforts with
  private providers.
• Netcare911 Ambulance and relief mission to
  Phuket led by South African private firm in
  coordination with government and volunteer groups.

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AM Mixed Public Private

• San Mateo County Hospital Advanced Life Support
  Services
• San Mateo County (SMC) American Medical
  Response
• First response fire agency paramedics.
• Second response Ambulance, medical supplies,
  equipment, training, clinical oversight.
• Both fire and AMR share revenue and both suffer
  penalties.
• Benefits?
• SMC increased certified and licensed paramedics
  from 60 to 220.
• On time response 98 for first response, 95 for
  second.
• Excellent ambulance (private) and fire (public)
  staff relations.

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AM Mixed Public Private

• Billing
• AMR taking over billing collection in many
  cities.
• Increases recovery at a lower price.
• Technology
• Small Belgian ambulance company Van Damme
  partnered with government and Nokia to test new
  ASTRID communications technology.
• Dispatch Services
• Benoni (South Africa)
• Metrocare (New York)

• Intergraph BEST (Melbourne)

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AM Mixed Public Private

• Ontario Air Ambulance Services Corporation
• Government organised non-profit to coordinate air
  rescue operations.
• Consolidating Emergency Health Services Branch,
  the Sunnybrook and Women's College Health
  Sciences Centre and private air operators.
• Why?

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AM Mixed Public Private

• One point of contact for the entire system with
  better co-ordination and quicker patient
  transfers.
• Direct medical supervision reaching every part of
  the operations, ensuring safe, effective
  treatment of patients.
• Dispatch and operations working together for more
  effective use of air ambulance resources.
• Improved awareness for health care service
  providers, of available air ambulance services.

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AM Contractors

• Denmark celebrating 100 years of private
  ambulance service in 2006 (Falck, 85 coverage).
• Falck also in Sweden, Poland, Norway and growing.
• United States and Canada Classic growth and
  consolidation.
• Rural/Metro started as a fire service company,
  now provides ambulance services and billing.
• Laidlaw of Canada absorbed American Medical
  Response (still named AMR).

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AM Managed Competition

• Pinellas County (Florida)
• Awarded contract to Sunstar after competitive
  budding with public and private providers.
• Benefits?
• Response times down by 30 seconds.
• Non-emergency response compliance rose from 90
  to 95.
• Equipment and software upgraded.
• All ambulances replaced every 5 years.
• Savings up to 21million over the next 7 years.

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AM Outsourcing - BFES

• Benoni Fire and Emergency Services (BFES)
• Founded by fire chief Steven Barber in 1992.
• Private investors.
• Saved Benoni local authority about R21million
  over 7 years.
• BFES college provides entry point to workforce
  for unskilled workers.
• More flexible work conditions for employees.

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AM Outsourcing BFES

• Now?
• Rescue Medics - Ambulance services
• Forest Firefighting
• Emergency Services Communications
• Emergency Service Vehicles (manufacture and
  upgrade)
• Emergency Services College
• Many imitators in South Africa, bidding on
  contracts in the UK.

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AM Co-ops

• CETAM
• La Coopérative des technicians ambulanciers de la
  Montérégie
• Ambulance technicians created a cooperative to
  provide ambulance services
• Union and Caisse populaire assistance in
  launching
• Workers are owners
• Acquired 7 more companies
• Now serves 70 municipalities
• Could you all be owners some day?

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Learning Experiences

• US Experience Best results with mixed services.
  Fire services first response, ALS and other
  ambulance services next response.
• South Africa full outsourcing.
• Ontario experimenting with non-profit
  corporation for Air Services.
• Quebec Co-ops like CETAM and Urgences-Santé.
• Belgium, Denmark, Sweden, Norway outsourcing
  for decades.

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Lessons Learned!

• Structure Is King
• Key design features
• Flexible Production Strategy
• Peak-Load Staffing
• Event-Driven Deployment
• Performance-Based Contracting
• Competitive Bidding (public and private)
• Creativity in Contracting

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Benefits of Alternative Models

• Flexibility and lower stress for workers
• Cost-savings allow investment in
• Training
• Equipment
• Modernisation
• Improved Service Levels
• Bonuses for performance
• Innovation in service
• Best combination of public and private provision

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• Are we being left behind?
• Can Hong Kong catch up to the worlds best and
  lead Asia?

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• Andrew WorkExecutive DirectorEmail
  andrewwork_at_lionrockinstitute.org
• 8th Floor Henley Building, 5 Queens Road
  Central, HK
• Tel [phone]
• Fax [phone]