Time Is Money, But How Much? The Monetary Value of Response Time for Ambulance

This study shows that using a logistic regression analysis makes it possible to find a correlation between response time and the severeness of injury.

The monetary values for ambulance emergency services were calculated for two different time factors, response time, which is the time from when a call is received by the emergency medical service call-taking center until the response team arrives at the emergency scene, and operational time, which includes the time to the hospital. The study was performed in two steps. First, marginal effects of reduced fatalities and injuries for a 1-minute change in the time factors were calculated. Second, the marginal effects and the monetary values were put together to find a value per minute.

The values were found to be 5.5 million Thai bath/min (129.000 Eur/min) for fatality and 326,000 baht/min (7674 Eur/min) for severe injury. The total monetary value for a 1-minute improvement for each dispatch, summarized over 1 year, was 1.6 billion Thai baht (Eur 37,6 million) using response time.

The calculated values could be used in a cost-benefit analysis of an investment reducing the response time. The results from similar studies could for example be compared to the cost of moving an ambulance station or investing in a new alarm system.

The success of all emergency responses is dependent on the time taken to get to the place where someone is lying ill or where a traffic accident has occurred. The faster the response the better the outcome will be. Hence, it is reasonable to say that all efforts should be made to decrease the time factor in the alarm chain from calling to taking the call, to dispatching, to getting ready to leave, to driving to the injured or accident, to taking care of the injured or suppressing the fire, and to getting the injured to hospital. On the other hand, should all efforts be made solely to decrease the time factor? Such efforts are costly and there are other health matters that could be invested in: better ambulances with more technical equipment, more training of the staff, better hospitals, provision of self-help equipment etc. The economical way of dealing with this problem of the public sector is to perform cost-benefit analyses. If benefits outweigh costs, in monetary terms, then an investment should be made since it can be said to increase welfare in society. If costs outweigh benefits, the investment should not be made.

The purpose of this study is to find a monetary value for the time factor of the emergency responses in Thailand.

It is not a cost-benefit analysis, since it only considers the benefit side of the time factor.
Notwithstanding, the results of the study could be used in a cost-benefit analysis. For example, if the Thai emergency sector intends to invest in new alarm technology that could save 1 minute in response time for all responses, how much will such an investment lead to in benefits measured in economic welfare terms?

As noted by Blanchard et al. (2012), there are only a few studies on the relation between the response time of emergency medical service (EMS) and the saving of lives. When it comes to cardiac arrest, reducing ambulance response time has been shown to increase survival rate (Pons et al. 2005; Pell et al. 2001; O’Keefe et al. 2011). Gonzales et al. (2009) found increased EMS pre-hospital time to be associated with higher mortality rates. Using fire and rescue services, which have shorter response times than traditional ambulances for health care responses, has been found to increase survival rate (Mattsson and Juås 1997; Jaldell 2004; Sund et al. 2011). However, there are also studies that have concluded that there is no relation between the response time and outcome of the patient (Blackwell et al. 2002; Blackwell et al. 2009; Pons and Markovchick 2002).

There are five motivations behind this paper. The first is that, as noted above, there is not much research done on the effect of the response time. The second is that most of the studies mentioned have taken up one health problem (cardiac arrest), while from a planning perspective there are of course many more reasons for having ambulance services. Furthermore, most of the analyses have evaluated the 8-minute response time goal for American ALS units responding to life-threatening events, for example, by comparing the survival rate below or above the 8-minute response time using non-continuous measures of response time. This analysis focuses instead on a continuous measure of the response time. The third is that this study examines not only the relation between response time and mortality, but also the effect of the illness condition for non-mortality cases. The fourth is that the number of observations in this study is over a million, compared to hundreds or thousands in the papers mentioned above. The fifth is that the analysis done does not stop at the outcome of the patient, but instead takes on an economic perspective, where the purpose is to find a monetary value for the total benefits of reducing the response time. This value could be used in a 4 cost-benefit analysis for evaluating investments in new alarm technology that would speed-up the
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