REGIONAL REPORT : Paramedic Fees Ride to Rescue of City Budgets : Government: Prepaid subscription charges for ambulance services are touted as a way to raise revenue. For consumers, program is like buying insurance.

A kind of emergency health insurance is catching on in Southern California, one that can save money for families and put money in the thin pockets of cash-starved cities, too.

The “insurance” is a voluntary “pre-need” subscription fee for paramedic service.

A single call to paramedics--even if all the patient ends up needing is a bandage--can cost the patient $100 or more in many Southern California cities.

Now, in some of those cities, a yearly prepaid fee ranging from $13 to $36 can cover all paramedic fees and, in some cases, ambulance service for an entire household.

“This is an excellent service for those people who cannot afford substantial medical insurance, and it’s also a good deal for those people whose health insurance has high deductibles,” said Eric Widell, paramedic coordinator for Santa Ana. The city began prepaid subscription service for paramedics and ambulances about two years ago. The subscription fee is $35 a year.

Because not everyone uses paramedics in a given year, cities usually make money on the subscription service. In some cities, such as Huntington Beach, the profit has been plowed back into improving the paramedic system.

“This program has been very successful in Huntington Beach, and we’ve been able to hire nine additional firefighter-paramedics and obtain two new paramedic vans since we started the program in July, 1990,” said Richard Kaump, the city’s coordinator of the subscription program.

Sign-ups range from 60% of households in Downey to 4% in Santa Ana. City profits vary and figures were not available. But cities that offer the program say their paramedic services now operate in the black, in part because of the subscription service.

No statewide records are kept on how many cities have the prepaid service. But fire officials say the idea is spreading rapidly in Southern California and has been particularly popular in Orange County, where the 8-year-old Fullerton program was one of the state’s first.

Los Angeles Fire Department Capt. Robert S. Roy, who is assembling a version of the program to present to the City Council by April, has surveyed agencies statewide and was particularly impressed by the Orange County model, which he said is popular with cities and “well received by the people.”

The Los Angeles Fire Department does not offer a prepaid paramedic subscription program. But Roy said his proposal would bill households that want the service $3 a month--$36 a year--for a prepaid combination of paramedic and ambulance service.

“The fact that a program like this is not mandatory is one of its selling points,” Roy said. “People don’t have to subscribe to get emergency medical service.” But people who do sign up are not billed for paramedic services they use.

Virtually all cities charge for ambulance service; the consumer’s cost for a routine ambulance run can be as high as $350.

The proposed Los Angeles subscription program would cover everyone in a household for an unlimited number of paramedic visits and ambulance calls for one year.

Cities that have adopted the prepaid coverage insist that no one is denied paramedic help. In Huntington Beach, the ordinance spells out that no one can be excluded or favored based on whether they had subscribed. It is not, as its critics feared, like the coverage of some volunteer fire departments, in which people who do not pay the subscription fee find that if their houses catch fire, they are left to burn.

In debating whether to establish subscription services, some city council members around the Southland have voiced fears that such a program would be elitist and discriminate against the poor.

No cases charging discrimination have surfaced. Fire officials say paramedics scrupulously respond to all calls. To do otherwise, officials say, would not only be unethical but would invite multimillion-dollar lawsuits.

Roy said such plans actually benefit the poor.

“A program such as this is especially helpful for people--and there are more of them now--who don’t have regular health insurance,” Roy said. He added that the proposed Los Angeles program would offer reduced fees, or no fees at all, for low-income families wishing to sign up. A no-fee sign-up, like a paid subscription, would mean a family could not be billed for services.

Roy stressed that regardless of subscription coverage, no one would be denied paramedic or ambulance service.

Nonetheless, some city officials say they have reservations about subscription plans. In Huntington Beach in 1989, then-Councilman Wes Bannister voted against the subscription plan, and said in a recent interview that he still has concerns.

“I don’t see governments ever being efficient in this sort of thing,” said Bannister, an insurance executive who was the Republican nominee for state insurance commissioner in 1990.

Huntington Beach’s paramedic-ambulance subscription plan, however, is frequently held up as a model. “We’ve had people come here (Huntington Beach) to study our program from many other cities in the state and from cities in the eastern and Midwestern part of the country,” Kaump said. “Our membership rate is high here in Huntington Beach. About 32% of the homes in the city have signed up.”

By contrast, nearby Santa Ana only has about a 4% participation rate, Widell said. “Cities such as Huntington Beach, that can bill for the service on their utility bills, have a higher participation rate,” Widell said. “In Santa Ana, we have to send out separate bills, and that works against us. We also have a problem with demographics; we have a large non-English-speaking population in the city.”

But despite its low participation rate, Santa Ana’s program operates at a profit, Widell said.

In Fullerton, the Fire Department offers subscription coverage for paramedic fees, but not for ambulance service. The Fullerton program, launched in 1983, costs $18 a year, and about 45% of households are subscribers. “I think it’s quite successful; it’s been well received in our city,” said Joy Brown, operations secretary for the Fire Department.

Like Fullerton, Downey’s Fire Department offers subscription service for paramedic fees but not for ambulance use. The annual fee in Downey is $15.75, and city officials say that about 60% of households subscribe.

In Alhambra, paramedic service is free but a basic emergency ambulance call can cost a householder $350. The city offers a subscription service that provides coverage for both ambulance service and bottled oxygen use for $27 a year. About 25% of households subscribe to the ambulance coverage.

In San Diego and Ventura counties, fire officials said they are watching the outcome of the Los Angeles proposal and hope to “see if it would be applicable down here,” said San Diego Division Chief Jerry Cannon.

In Carlsbad, Fire Battalion Chief Brian Watson said subscription service for paramedics “is something we might be looking at in the future.”

In Ventura County, a program has been suggested as a way to start paramedic service, which the Fire Department does not have. “We think a subscription plan could raise enough money to start a paramedic program in the department,” said Ken Maffei, president of the Ventura County Professional Firefighters Assn.

“Right now, with only private ambulance service, residents in Ventura County have to pay $600 to $800 for paramedic service,” Maffei said. “It would certainly be a lot cheaper for them if we had county Fire Department paramedics and a subscription plan. I see a subscription plan as sort of like an insurance policy.”

Paramedic ‘Insurance’

Several Southern California cities now offer something like an insurance policy for paramedic fees. For an annual subscription fee, a household can be covered against any costs for paramedic service. In some cities, the fee also includes coverage against ambulance costs. Here are some cities now offering such paramedic subscription plans.

CITY COVERAGE ANNUAL FEE Alhambra ambulance/oxygen $27 Anaheim paramedic fees $36 Buena Park paramedic fees $36 Downey paramedic fees $15.75 Fullerton paramedic fees $18 Huntington Beach paramedic fees/ambulance $36 Santa Ana paramedic fees/ambulance $35

SOURCE: Individual cities