Not Free Anymore for Taipei City Ambulance? ——A Possible New Change

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Emergency medical system (EMS) has always been the first-line help for citizens, particularly during emergencies, just like everyone knows ambulances are designed for people requiring immediate medical assistance. Instead of calling 9-1-1, people in Taiwan dial 1-1-9 while there’s an urgent medical condition, and the ambulance would come in minutes to transport the patient to medical facilities–free of charge. But problems exist because there’re individuals who tend to abuse the ambulance use, calling just for minor ailments even alcohol intoxication.
Emergency ambulance are NOT taxis.

Such calls have placed unnecessary burdens on EMS medical teams and affected the system’s providing service to those who are in genuine need. Although the whole Taipei City fire department is equipped with 78 ambulances and 200 ambulance corps members, there is an average of 400 emergency calls every day to handle. While there’s only one at most two ambulances in one precinct, if one ambulance is called out, the region would have to be supported by neighboring teams in the following one hour.
Taipei EMS Dispatches Statistics (Source: Taipei City Fire Department)

Taipei City government has long been considering implementation of charges for ambulance transportation on people who use the service for non-emergency conditions, a fee of NT$1,800 (about USD$60), including NT$800 for ambulance transport and NT$1,000 for the two accompanying paramedics, which is levied in accordance with the Emergency Medical Care Act. Yet it was not enforced except for some extreme cases until lately, the new Taipei City mayor has determined to extend the policy.

Based on the spirit of “users pay” and “leaving the resources to whoever in real need”, Dr. Wen-Je Ko—the current Taipei City mayor and also a former trauma surgeon as well as ER chief—believed that the charges should be applied on all patients that are not true emergencies, such as level 4 or 5 patients at ER triage. There are arguments and criticism from other sectors toward this policy, however, worrying the impact on the underprivileged or social vulnerable groups that could prevent them from seeking medical help. The city government promised that the measure would not affect people’s right to emergency medical services: the ambulance service would remain free if people call for real emergencies. Taipei City Fire Department has been working with Department of Health and the City EMS review committee, to organize and plan more comprehensive rules of ambulance charging, which are expected to be on the way recently.

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6 Responses to “Not Free Anymore for Taipei City Ambulance? ——A Possible New Change”

  1. nkoba1 Says:

    This is very interesting discussion because the similar problems happens in Japan as well. Since I also experienced not-emergent cases as a physician, I can understand the exhausted front-line in emergency medicine. I think that the key point about this problem is how and who judge whether this case is emergent or not. Since patients can’t judge the level of seriousness of the disease, they call for an ambulance. I used to see the very serious and emergent case although the patient doesn’t notice the emergent situation, and vice versa. Whichever Taipei people introduce this policy or not, the strong consensus what extend people can use the ambulance should be formed through the deep discussion.

  2. ndanm Says:

    I also find this interesting how does one know if their situation is considered am emergency or not. It’s really difficult to say it’s not an emergency when that person actually feels they are in an urgent situation. I have also noticed that in my country they actually don’t even send the ambulance anymore. They also have their own cretria of what’s considered an emergency and the other reason is the shortage of personal to cater to these situations.

  3. dsloan2 Says:

    I agree with previous posters on this topic. I think that charging for the ambulance ride will make “consumers” more conscientious of what financial burden is associated with this type of medical attention. Just as the health care system is moving towards creating a more conscious consumer, I think policies like this around the globe push for the same values and are necessary. The issue does come with who makes the call on what is exactly an emergency and what algorithms will be in place to alleviate any risk the trained EMS officials will have to take to when making these “calls.”

  4. ynangwenyi Says:

    What a fascinating topic! Not surprised that the mayor of Taipei City is getting criticized for this move. But on the other hand, health resources are not unlimited and the government/hospitals/taxpayers have to pay for them (even though it may be “free” for the people being transported). And I think it does a disservice to provide brief episodic care in extremes, without access to primary healthcare.

    It’s true that many people cannot accurately determine if their symptoms are a “true” emergency or not…and there’s a real risk to vulnerable populations who have limited access to other health services. So, bolstering other systems can provide alternatives to those in need. This can be an opportunity to focus on prevention and directing people to other settings like urgent care centers.

  5. davidugai Says:

    I also agree with many of the comments above. This is a great topic and a very interesting idea/method for solving the problem of people misusing the use of emergency transport services. I think that charging patients that do not require this service would be an appropriate intervention to help curb the overuse of this service when not needed. There is a major downside for charging for services based on the type of emergency. Many patients when calling for emergency services are not aware if the issue is an emergency or not. They may not have transport to a medical center and would require transport services. If the policy requires charging all people for non-emergency transport, this may cause many people to not make the call for this service. There would have to be careful consideration to make sure that this would not create a problem for the “poor” sectors of the population.

  6. treza1 Says:

    This is a very important topic. It’s good to know that Taipei city has the emergency medical system. I believe, every country should have this system even if its in the small scale. I am from Bangladesh. In Bangladesh, we do not have this system which is causing so many disability and death for just not having the accessibility of treatment on right time. I believe, most of the third world countries do not have this system while it is an essential need. However, I also do not support the “user pay” system. If people have to pay then many people from lower socio-economic status wouldn’t be able to use it which in turn again will increase the social burden of diseases, disability or death. I hope, they would reconsider the policy before implication.

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