4- Intl Survey Ambulances (a Work) Lion Rock Inst_e

8/3/2019 4- Intl Survey Ambulances (a Work) Lion Rock Inst_e

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International Survey on

Ambulance Services: Alternative Models

Friday, October 28th, 2005

The Museum of History

Hong Kong



The Lion Rock Institute

• Independent public policy think tank

• Dedicated to researching, generating and advocating public policy solutions for a freer and more prosperous

Hong Kong • Also involved in education of policy makers and the

general public

• Importing the world’s best, exporting Hong Kong’sbest practices to the world.

• Three co-founders + 6 person Board of Advisors fromHong Kong and abroad

• A new type of organisation in Hong Kong and growing.



Today’s Objectives

• Generate awareness of alternative

models, benefits and challenges.

• Launch a discussion of what can bedone to bring better ambulance service

to Hong Kong, among the people who

know the system best – you.

• Raise the bar!



Could we be doing better?

• Not the drivers, not the

funding – it’s the system.

• Ambulance Medical Priority

Dispatch System? “20 years

behind the USA” – CUHK AEMAU



Could we be doing better? (II)

• Labour Disputes over working

conditions “I’m not done my

lunch!”

• Excessive stress levels.

• Cutbacks to funding.



• 180 of 215 ambulances running

(2003).

• Calls expanding 5-7%/year.

• Resource allocation – Disney over

Mui Wo?

• Standards below OECD norms.

Could we be doing better? (III)



Why Alternative Models?

• Response times: Los Angeles 5-8 minutes, Chicago 4-6

minutes.

• Higher percentage response compliance (normally over

95%).

• Technology – More new technology and newer equipment

in many alternative model systems.

• Cost savings – Stockholm, Benoni (SA), San Mateo,

Pinellas, Michigan, Ontario, more.• More savings means more development of people and staff.

San Mateo increased paramedic staff from 60 to 220. BFES

(SA) runs its own training school.



What Alternative Models?

USA Private For-Profit 34.5%

Fire depts. using multi-role personnel 34%

Third-service agencies 12%

Private nonprofit agencies 5%

Fire depts. using single-role person 5%

Public Utility Model 5%

Hospital based Services 3%

Volunteer 1%

+ Co-ops in Canada!

2000 Journal of Emergency Medical Services (JEMS) survey



AM: Problems?

• Oversight – billing, inexperience by

overseers.

• Labour Disputes. (Netherlands retirement)

• Change in government policies leads to

confusion. (US Medicare and billing)

• Minor, related to administration – no

evidence of decline in quality of service.



Where?• Canada

• USA

• Belgium

• India

• Botswana

• The Netherlands

• Australia

• Denmark • Sweden

• Norway

• South Africa

• Philippines

• And many more!

Soon, Hong Kong will be the

alternative!



AM: Volunteer Services

• India: Sri Gian Sthal Mandir sabha –

provides ambulance service for widows in

Ludhiana, India.

• Pamilya Mo, Lingap Ko – Philippine

National Red Cross and Rizal Commerical

Banking Corporation – ambulance services

for OFW.

• Small town America, Canada, and even

Hong Kong (St. John’s Ambulance pre-

hospital care at events).



AM: Volunteer - Private - Government

• Dunlip County, North Carolina – Volunteer service

under pressure as people spend more time at work.

Considering mixing volunteer efforts with private providers.

• Netcare911 – Ambulance and relief mission to

Phuket led by South African private firm incoordination with government and volunteer

groups.



AM: Mixed Public Private

San Mateo County Hospital Advanced Life Support Services• San Mateo County (SMC) + American Medical Response

• First response – fire agency paramedics.

• Second response – Ambulance, medical supplies,equipment, training, clinical oversight.

• Both fire and AMR share revenue and both sufferpenalties.

Benefits?

• SMC increased certified and licensed paramedics from 60to 220.

• On time response: 98% for first response, 95% for second.

•

Excellent ambulance (private) and fire (public) staff relations.



Billing

• AMR taking over billing collection in many cities.

• Increases % recovery at a lower price.

Technology

• Small Belgian ambulance company Van Damme partnered with government and Nokia to test new

ASTRID communications technology.Dispatch Services

• Benoni (South Africa)

• Metrocare (New York)


• Intergraph BEST

(Melbourne)



Ontario Air Ambulance Services Corporation

• Government organised non-profit to coordinate

air rescue operations.

• Consolidating: Emergency Health Services

Branch, the Sunnybrook and Women's College

Health Sciences Centre and private air

operators.

Why?




• One point of contact for the entire system withbetter co-ordination and quicker patient transfers.

• Direct medical supervision reaching every part of

the operations, ensuring safe, effective treatment ofpatients.

• Dispatch and operations working together for more

effective use of air ambulance resources.• Improved awareness for health care service

providers, of available air ambulance services.




AM: Contractors

• Denmark celebrating 100 years of private

ambulance service in 2006 (Falck, 85% coverage).

• Falck also in Sweden, Poland, Norway and

growing.

• United States and Canada – Classic growth and

consolidation.

– Rural/Metro – started as a fire service company, now

provides ambulance services and billing.

– Laidlaw of Canada absorbed American Medical

Response (still named AMR).



AM: Managed Competition

Pinellas County (Florida)

•Awarded contract to Sunstar after competitive budding with public

and private providers.

Benefits?

•Response times down by 30 seconds.

•Non-emergency response compliance rose from 90% to 95%.

•Equipment and software upgraded.

•All ambulances replaced every 5 years.

•Savings up to $21million over the next 7 years.



AM: Outsourcing - BFES

Benoni Fire and Emergency Services (BFES)

• Founded by fire chief Steven Barber in 1992.

• Private investors.

• Saved Benoni local authority about R21million over

7 years.

• BFES college provides entry point to workforce for

unskilled workers.

• More flexible work conditions for employees.



AM: Outsourcing BFES

Now?

• Rescue Medics - Ambulance services

• Forest Firefighting• Emergency Services Communications

• Emergency Service Vehicles (manufacture

and upgrade)• Emergency Services College

• Many imitators in South Africa, bidding on

contracts in the UK.



AM: Co-ops

CETAM

La Coopérative des technicians ambulanciers de la Montérégie

• Ambulance technicians created a cooperative to provide

ambulance services

• Union and Caisse populaire assistance in launching

• Workers are owners

• Acquired 7 more companies

• Now serves 70 municipalities

Could you all be owners some day?



Learning Experiences

• US Experience – Best results with mixedservices. Fire services first response, ALSand other ambulance services next response.

• South Africa – full outsourcing.

• Ontario – experimenting with non-profitcorporation for Air Services.

• Quebec – Co-ops like CETAM andUrgences-Santé.

• Belgium, Denmark, Sweden, Norway –

outsourcing for decades.



Lessons Learned!

• Structure Is King

• Key design features:

– Flexible Production Strategy – Peak-Load Staffing

– Event-Driven Deployment

– Performance-Based Contracting – Competitive Bidding (public and private)

– Creativity in Contracting



Benefits of Alternative

Models

• Flexibility and lower stress for workers

• Cost-savings allow investment in:

– Training

– Equipment

– Modernisation

• Improved Service Levels

• Bonuses for performance

• Innovation in service

• Best combination of public and private provision



Are we being left behind?

Can Hong Kong catch up tothe world’s best and lead

Asia?



• Andrew Work

Executive Director

Email: [email protected]

• 8th Floor Henley Building, 5 Queen’s Road Central, HK

• Tel: (852) 2845 4544

• Fax: (852) 3015 2186

mailto:[email protected]

mailto:[email protected]

Documents

4- Intl Survey Ambulances (a Work) Lion Rock Inst_e