In Britain, Careline is a service much like LifeCall – you know, help me I can’t get up. It is offered, is far as I can tell by the local government of King’s Lynn & West Norfolk. For a sum of a little over $26/month you get a pendant, answered within 16 seconds, to assist you. As with the US equivalents, medical help is dispatched to your aid. But what I found fascinating was that one of the towns that provide this service had added a new surcharge – dubbed by critics as a ‘falling fee.’
“At the moment, Careline users who fall at home have to wait for a paramedic to help them. But under the new policy, Careline staff will go to their aid and get the user sitting up and assess the situation before an ambulance is called, in a bid to cut the number of call-outs to falls paramedics receive.”
The additional cost, roughly $32. Dispatching an ambulance costs the National Health Service about $165, and is a growing problem. I admit I was drawn to the article (pointed out by the always informative Marginal Revolution) because of my sense of humor. After all, as the article says, "These people will have no other option but to pay because if they don't, they're going to be lying there on the floor aren't they?"
Hidden within the article is a point worth considering – what are our costs for medical transportation? Non-emergent medical transportation that helps get patients to their physicians or other care facilities like physical therapy or dialysis involves up to 111 million trips at the cost of nearly $1.8 billion, for an average national cost of $16 per trip. For low-income individuals, the situation is worse as their lack of disposable income may result in the lack of “access to a working automobile, and may lack public transit options to get to and from medical appointments.” While transportation costs are only about 1% of Medicaid’s costs, it is $3 billion annually.
Interestingly, there may be a solution from the digital, disruptive economy. Lyft is being utilized in New York to provide these services. As pointed out by a commentary in JAMA in September, the car services already being used are so unreliable that they are associated with an increased risk of missing dialysis appointments. The early data from Lyft show a decrease in waiting time for the patients of about 30% and a similar reduction in the cost of 32.4% or a savings of a little more than $10 per ride.
