Emergency Medical Services in Maine: Rural Vs Urban Systems

摘要

Emergency Medical Services (EMS) in rural and super rural regions in the United States often suffer from human resource and financial difficulties. Times and distances traveled are longer for rural EMS responders, and the closure of Critical Access Hospitals in rural areas lengthens these. Super rural and rural EMS systems are more dependent on volunteers, which come with their own recruitment and retention problems. Rural EMS systems have greater funding difficulties, as they tend not to get tax subsidies. Lastly, rural areas tend to have low EMS call volumes, reducing revenues from insurance and Medicare/Medicaid, which in any case tend not to cover costs sufficiently. The author used a system dynamics model to test three policies: (1) increased payments on a stepped basis, (2) consistent yearly increases, and (3) consolidation of super rural EMS systems, to reduce travel costs. Increasing payments sporadically was not effective, as costs rose constantly and not in synch with this policy's stepwise approach. Consistent yearly increases were more effective, but cost increases reduced its effectiveness, implying the need for indexed payment increases. Lastly, consolidation was an effective policy (although not as effective as indexed payment increases), but comes with bureaucratic and operational difficulties.