Hey fellow AMR employees! Mind helping us out?

[Dustdevil]

This is a symptom of placing public health in the hands of private industry.

Stick to EMS, Fiz. You're becoming a fine medic, but you have zero future as an economist.

Find me one area of the United States where anybody with a choice would rather be admitted to the county hospital, military hospital, or VA hospital instead of the nice posh private hospital down the street. Most people would rather gnaw their arm off. But how can this be? How can government -- the lord and saviour of public health -- be running a facility that nobody with a choice would choose to go to? How is it that all these evil, for profit, private hospitals provide such a substantially a better product that even the uneducated general public knows it and chooses it? And even more relevant to you, why is it that most medical professionals would also rather work at those hospitals than the county/military/VA hospitals? Use your head, Bro.

You could not be more wrong. This is not a symptom of placing public health in the hands of private industry. This is a symptom of a shyte EMS system. EMS sucks in this country, no matter who is running it. I know you guys up north are all about your benefits and your unions, and so long as you like your contract, the quality of the service provided is not a real concern to you. But that's not how all of us look at it in the real world. For every private service you show me that sucks, I'll show you two FD services that suck as bad or worse. The only difference is the pay and security, which matters nada to your patients.

You're barking up the wrong tree. Government screwed up EMS in the first place. I certainly don't trust them to fix it.

[Doug]

oh boy, here we go...private vs. muni....i still think a private service is the way to go....have to agree that buckethead EMS is dangerous...can't serve 2 masters..and you can't fire them either...trust me i've seen it tried.

[fiznat]

The reason I feel the way I do is because I believe that EMS should be a public service. I believe that interest in profit margins does not always correlate with quality service. In fact, it is VERY often that the opposite is actually true.

You are wrong in your assumption that I want municipal funding because I think it will benefit ME. To the contrary, I feel that if the service is funded without hope of profit, the only benchmark that need be placed is on quality service. EMS is an expensive proposition with very little hope of recouping the money spent. At the same time it is an essential service that any county/city/town cannot do without. Those two points together seem (to me) to suggest that it should be publicly funded.

I am actually against socialized medicine. I agree with you that the VA sucks, that the government in general does a poor job of regulating medical care. Still though, I think EMS should be a municipal service because - unlike the hospital - it is a public service that cannot be performed properly while maintaining any hope that profit can be made.

I know you guys up north are all about your benefits and your unions, and so long as you like your contract, the quality of the service provided is not a real concern to you. But that's not how all of us look at it in the real world.

That is a bit harsh. There was a 2nd paragraph to the post you replied to-- re-read that!

[Doug]

Not sure how it is where you are but EMS, unlike fire supresion and law enforcement are not compulsary services in Mass. That is to say a town DOES NOT HAVE TO PROVIDE IT in order to incorporate and they do not have to set up a mutual aide system to provide for it either. I know a few inspectors for the state and have been told that they judge muni services on a different scale than private services because if they actually enforce the violations there is NOBODY else to do the job. And the unofficial line is something is better than nothing. Besides any fines that are levied against thses services just comes out of the towns....which they in turn look to the state to recoup...in our area it was the private services that were at the forefront of complying with new requirements...the introduction of 12 leads was delayed for a year because some muni services didn't have the funds to purchase new equipment...we had them and were using them...

[Dustdevil]

The reason I feel the way I do is because I believe that EMS should be a public service. I believe that interest in profit margins does not always correlate with quality service. In fact, it is VERY often that the opposite is actually true.

O RLY? Then how do you explain the hospital phenomenon? How do you explain the difference in quality between the top private colleges and the top public colleges? Profit doesn't seem to be hurting their quality.

I feel that if the service is funded without hope of profit, the only benchmark that need be placed is on quality service.

Dude, I want some of whatever you are smoking! Find me more than a handful of cities that run a service like that. They all cater to the bottom line. That is why so many of them combine with the FD, simply to save money, regardless of the effect on quality. Obviously you have never worked for a government service. I have. I know the grass always looks greener on the other side, especially when you start comparing your single function salary to that of dual function firemonkeys, but that green is an illusion. And you know what? Those that cater to the bottom line best, pay their chief administrators major bank. It may not be about "profit," but it is still always about money. The only difference is who profits.

I am actually against socialized medicine. I agree with you that the VA sucks, that the government in general does a poor job of regulating medical care. Still though, I think EMS should be a municipal service because - unlike the hospital - it is a public service that cannot be performed properly while maintaining any hope that profit can be made.

Nice theory, but it doesn't pan out in practice, because even when you take away any focus on profit, the service they provide still sucks. Again, government generally proves itself to provide very poor healthcare, whether it be in EMS, or in hospitals, or in Medicare/Medicaid, etc... You don't have to be profit motivated to suck. In fact, profit motivation does much to prevent suckage, because nobody will buy your product if it sucks. When government provides the product, they have zero motivation to excel or provide a superior product, resulting in guaranteed suckage. At least with private enterprise you have a chance of excellence.

Congratulations, you have just convinced me to add Economics 101 to the required course list for future EMS degrees.

[fiznat]

O RLY? Then how do you explain the hospital phenomenon? How do you explain the difference in quality between the top private colleges and the top public colleges? Profit doesn't seem to be hurting their quality.

YA RLY. lol.

The hospital phenomenon? What do you mean by that? If we are going to be fair and compare hospitals to EMS as far as ability to produce profit, then we will have to compare the ambulance with JUST the ED. If we do that, I think you'll find that the hospital would be in a very similar financial position if it weren't for high dollar procedures and surgeries on the upper floors that are consistently and regularly paid for by insurance companies. There is a portion of the hospital that is allowed to pick and choose patients, a decision that I dont doubt it as at least somewhat effected by the all-important "ability to pay" factor. That is how hospitals are able to stay afloat, if they even do at all (because still there are hospitals that are on the financial razor's edge). The ED works because it's annual deficit is supported by the rest of the hospital.

Is it no surprise that the perceived "quality" of a hospital often has more to do with the availability of high dollar surgical options, equipment, and personnel rather than the effectiveness of it's emergency department? Tell me which advertisements you see more: for a specialized ortho or cardiac group, or for timely care in the ED? I don't think I've EVER seen the latter. Hospital's brag and compare based on the 2nd floor and up, always. EMS has no second floor.

[Dustdevil]

YA RLY. lol.

I love it!

The hospital phenomenon? What do you mean by that? If we are going to be fair and compare hospitals to EMS as far as ability to produce profit, then we will have to compare the ambulance with JUST the ED.

All fair points. But the ability to produce profit isn't what we were talking about, was it? I dunno, maybe it was what you were talking about and I misunderstood, lol. But it wasn't what I was talking about. What I thought we were talking about was the potential for a private, for profit entity to provide a quality public service.

Anyhow, if we are talking about profits, then would you have a problem with a for-profit private running EMS if they were making a good profit? That seems to be what you are saying, in relation to the hospitals. You're saying they make a good profit, so it is okay. Does that mean that if a for-profit provider does not make a profit, it isn't okay?

I guess I'm just trying to understand exactly what the problem is that you are talking about. Is it that they make a profit? Is it that they provide a bad service? Is it something completely different?

I dunno, man... what I see a whole lot of in EMS is just a lot of wankers who are so eat up with the desire to be a civil service employee, like their heroes the firemen, that it becomes an overriding priority for them, regardless of anything else. I am just really hoping you are going to say something to reassure me that this isn't you, because I honestly have more faith in you than that.

[JPINFV]

YA RLY. lol.

The hospital phenomenon? What do you mean by that? If we are going to be fair and compare hospitals to EMS as far as ability to produce profit, then we will have to compare the ambulance with JUST the ED. If we do that, I think you'll find that the hospital would be in a very similar financial position if it weren't for high dollar procedures and surgeries on the upper floors that are consistently and regularly paid for by insurance companies. There is a portion of the hospital that is allowed to pick and choose patients, a decision that I dont doubt it as at least somewhat effected by the all-important "ability to pay" factor. That is how hospitals are able to stay afloat, if they even do at all (because still there are hospitals that are on the financial razor's edge). The ED works because it's annual deficit is supported by the rest of the hospital.

Is it no surprise that the perceived "quality" of a hospital often has more to do with the availability of high dollar surgical options, equipment, and personnel rather than the effectiveness of it's emergency department? Tell me which advertisements you see more: for a specialized ortho or cardiac group, or for timely care in the ED? I don't think I've EVER seen the latter. Hospital's brag and compare based on the 2nd floor and up, always. EMS has no second floor.

2 things.

First, while it's true that most emergency rooms, as a unit, are a losing venture, a large number of patients seen on the services that do make a profit makes their initial presentation to the emergency room. Saying that emergency rooms do not make a profit where the rest of the hospital does is like saying that the marketing department of a cooperation should be disbanded because they are supported with funding brought in by the sales department.

Second, I have seen advertisements for two hospitals emergency departments [Tustin Hospital and Tri-City Regional Medical Center].

[fiznat]

All fair points. But the ability to produce profit isn't what we were talking about, was it? I dunno, maybe it was what you were talking about and I misunderstood, lol. But it wasn't what I was talking about. What I thought we were talking about was the potential for a private, for profit entity to provide a quality public service.

Yeah I think so too haha. Since I think at this point we can abandon all hope of the original topic, I'll clarify:

I feel that the only part of the hospital that is providing a "public service" (in the respect that EMS does) is the Emergency Deparment. I was pointing out the fact that the only portion of the hospital that provides public service is also the only portion of the hospital that tends to run in the financial red. Providing a product (medical care) to anyone who wants it - with "instant credit" granted is loosing business. Collection rates are extremely low, costs are high, and legal liability is high.

You asked me to explain (I think? haha) how it is that private hospitals are able to provide high quality public service despite the fact that they are for-profit entities. My rebuttal is that ONLY the ED is truly public service, and ONLY the ED loses money! In fact it is not true that the hospitals are able to provide quality for-profit public service, because it would be unable to do so if it weren't for the support of the remaining, highly profitable non-public service departments.

The coorelation is that if a entity wants to provide a high quality public service, it is extremely difficult (if not impossible) to do so unless that entitiy is accepted as losing business, and funded by some other source. AMR manages to bridge this gap by providing a highly profitable non-public service which funds the 911 side of things: transfers. ...But as any AMR employee can attest, this arrangement tends to impinge on the QUALITY of the emergency service. With this experience in mind, it is my opinion that there are very few other arrangements that would make finance of 911 service possible while at the same time keeping quality high, except through municipal funding.

First, while it's true that most emergency rooms, as a unit, are a losing venture, a large number of patients seen on the services that do make a profit makes their initial presentation to the emergency room. Saying that emergency rooms do not make a profit where the rest of the hospital does is like saying that the marketing department of a cooperation should be disbanded because they are supported with funding brought in by the sales department.

I agree with you that a large percent of the profitable hospital patients do enter through the ED doors, but I disagree with you that the ED still needs to lose money. The marketing department of a cooperation loses money because it is nessary for that department to first make a faithful investment. There is no such requirement in the ED. The ED does not need to spend money to make money, because canidates for high-dollar procedures could be selected at the door and seperated from the rest of the non-paying population. It is the public service aspect of the ED (which I admit is required by law) which loses money. The private portion of the hospital (that which is not mandated by law) is the part that makes money. That is sortof my point: public service loses money, private business makes it (or fails).

I dunno, man... what I see a whole lot of in EMS is just a lot of wankers who are so eat up with the desire to be a civil service employee, like their heroes the firemen, that it becomes an overriding priority for them, regardless of anything else. I am just really hoping you are going to say something to reassure me that this isn't you, because I honestly have more faith in you than that.

I know what you mean man, and I hope you can believe (or at least see, by what I am saying) that this isn't my intent. I have no interest in fire whatsoever, and to be honest I dont think it would benefit EMS to be anything like them except in who pays the bills. Honestly I could give a shit about being a "hero" or whatever.. although I do believe that with quality service, education, and professionalism, that aspect would probably come on it's own.

[Just Plain Ruff]

I thought that quality of an ER was based on how fast they can get a doc to see you. I saw a ad somewhere that if you go to ER #1 you will be seen by a doc in 15 minutes.

Now that's quality.