Don’t Have a Coronary in Prime Time : Paramedics: L.A. has one of the nation’s least-efficient systems; privatizing could save lives and millions of dollars.
What if you had a heart attack and nobody came?
Los Angeles Fire Department paramedics are well-trained and dedicated, but at certain times of the day they can be overwhelmed by the number of emergency calls. So if you should need help at one of the busiest hours of the day, you might be out of luck.
Adding more paramedic units is not an option. Los Angeles is under severe budgetary pressures and the paramedic program already consumes $58 million a year. However, Reason Foundation research has determined that the problem is not money but the inefficient way in which the LAFD manages and deploys its paramedic resources.
Emergency medical calls show very predictable patterns of occurrence. Certain locations and certain times of day have much higher call volumes than others. Yet the LAFD, like most fire departments, has the same number of paramedics on duty at all times--far more than are needed at low-volume times and too few at the high-volume times. In addition, the units are based only at fire stations, poorly matched to the locations of medical calls.
This static deployment results in inefficiency and therefore much higher costs for a given level of service. One well-established measure of paramedic productivity is the fraction of time that units are involved in making patient transports. For the LAFD, that figure is between 23% and 27%--compared with high-performance systems that range from 35% to as high as 60%. The LAFD’s low productivity is the reason our cost per transport is $478, versus about half that sum in high-performance cities. Overall, Los Angeles ends up with one of the highest-cost paramedic systems in the nation--a taxpayer cost of $12.50 for every man, woman and child in Los Angeles--compared with $3 or less per person in such cities as Las Vegas, Fort Worth, Tex., Las Vegas, Kansas City, Mo., and Syracuse, N.Y.
We found three success factors common to all the high-performance systems:
* The paramedic service itself is provided by private firms, under contract to the city or county government, with the fire department technicians responding only on selected calls to supplement private paramedics.
* The private firms use computers to predict patterns of calls, by time of day and geographical area, and deploy people and equipment to match.
* The private firms are governed by enforceable contract standards for response time, tougher than any imposed on the LAFD. Typically, these standards require that 90% of all calls be responded to in eight minutes or less.
To establish such a system in Los Angeles, our midrange estimate was an annual cost of $30 million (compared with the current $58 million). Moreover, because a portion of the cost is recovered from patient billings and the private sector generally achieves a collection rate of 60% (compared with the LAFD’s 48%), we estimated that revenues would increase from today’s $12 million to $15 million. Net taxpayer cost would decrease by more than two-thirds of what it is now.
The Los Angeles Fire Department does not like these conclusions. Chief Donald Manning wrote a 22-page letter to Mayor Richard Riordan taking issue with our study. But we stand by our numbers. We’re convinced that Los Angeles can have a higher quality paramedic system at much lower cost, by following the example of other leading cities.
It’s high time that the mayor and City Council put this question on the table. It’s not simply a matter of money--there are lives at stake.
