Panel Paper: Did Uberx Reduce Ambulance Volume?

Thursday, November 8, 2018
Wilson C - Mezz Level (Marriott Wardman Park)

*Names in bold indicate Presenter

Leon Moskatel, Scripps Mercy Hospital and David Slusky, University of Kansas

We study the effect of Uber market entry on per capita ambulance volume. An ambulance ride can easily exceed over a thousand dollars, usually with great surprise to the patient. Insurance often only partially covers the expense or outright refuses to pay for transport deemed not medically necessary. Individuals often lack another means of transport and would use one if one existed (Billittier et al. 1996).

Many have now started to seek alternate, cheaper transport to the emergency room in the form of ride-sharing services such as Uber and Lyft. In addition, while ambulances typically route to the closest hospital, ride-sharing services allow the patient to choose to which hospital they present, a potentially important factor as these facilities may have differing results for the same illness, with higher-cost hospitals associated with better outcomes (Doyle, et al. 2015). Cities have noticed enough residents making this shift that they have discussed how these ride-sharing services could be integrated into their EMS frameworks.

We use quarterly 2013-2015 dates of Uber entry into different US markets from the Uber Newsroom blog and external publications. Ambulance rates were obtained from the National Emergency Medical Services Information System (NEMSIS). Our regression follows a generalized difference-in-differences framework at the city-quarter level. We have 797 city-state groups, splitting cities that cross state lines into two units.

Across a wide variety of specifications, we preliminarily find a 7% decrease in the per capita ambulance rate from Uber entry into a city. Given that even a reduction of a few minutes can drastically improve survival rates for serious conditions (Pell et al. 2001), this could be associated with a substantial welfare improvement. Additionally, consumers substituting to a cheaper alternative when possible would free up resources to be spent more efficiently. This result suggests that Uber entry into a city has positive impact, decreasing ambulance usage.

One other possibility is that Uber market entry reduced the need for ambulances due to reductions in auto accident related fatalities (including those involving alcohol). Given the mixed literature on Uber’s impact on accidents (Brazil and Kirk 2016; Dills and Mulholland, 2017; Greenwood and Wattal, 2017), this will need to be investigated further. We plan to do so in future analyses using additional data from NEMSIS. This including average response time between the 911 call and ambulance arrival, average travel time to the hospital, average symptom severity, the share of calls that are responding to car accidents, and the share of ambulances that are responding to car accidents that involve alcohol.

As ride-sharing services (e.g., Uber and Lyft) are now entering the health care transportation market, the results of our analysis are crucial to understanding their impact on emergency transportation. Ride-sharing availability can be a win-win, providing a low-cost substitute for those without life-threatening emergencies, and freeing up ambulances for those in dire need.