The Determinants of Urban Emergency Medical Services Privatization

Abstract:     
This paper undertakes an analysis of the decision to utilize public or private providers for the local provision of emergency medical services (EMS) in cities. We provide a historical overview of the EMS industry from the mid-1860s to the present day. EMS services are commonly broken into two components: first response and transport. While first response is generally kept within the purview of local fire departments, transport is maintained in-house by public agencies, contracted out to private providers, or provided by some combination of the two. The decision to employ public or private providers for EMS transport services involves a fundamental trade-off between incentives for innovation/flexibility among private providers and infrastructural advantages posed by maintaining in-house transport services. The degree to which cities value the competing advantages of each method of provision is a result of a number of city-level factors, including population, urban density, population age, health status, the likelihood of major emergency events, crime levels, the location of fire departments and trauma centers, and the strength of labor unions. This paper poses a number of hypotheses regarding how each of the above factors is likely to affect incentives to utilize public or private EMS providers. Some of these interactions are examined empirically using data on EMS contracting decisions in the 200 largest US cities. We conclude by discussing the strongest relationships between city-specific characteristics and the method of EMS provision, and identify avenues for future research in this arena.

Keywords: Privatization, Public Services, Emergency Medical Services, EMS

Accepted Paper Series