Keith Vodden Dr. Douglas Smith - Transports Canada

Ontario Model
6. Ambulance
The Ontario Ministry of Health & Long Term Care provides grants to cover the
cost of land ambulance services. Services are provided by approximately 60 certified land
based municipal, private hospital and volunteer operators—serving 440 individual
municipalities in Ontario. In 2004, there were over 1.6 million requests for land
ambulance service resulting in approximately 940,000 transports of more than 1.1 million
patients.
Those transported by land ambulance for a medically necessary trip, with a valid
Ontario Health Card and not subject to a Special Exemption category, are charged a copayment
of $45 toward the cost of their trip. Each person whose transport is deemed
medically unnecessary by the receiving hospital is charged a fixed $240 fee for a land
ambulance under the Health Insurance Act, Regulation 552. This later fee is unlikely to
reflect the full cost of the land ambulance trip.
Instead of this regulated charge we use the cost of $783 (2005 $) per transported
patient estimated based on data provided by the City of Toronto website. (The total
budget for Emergency Medical Services in Toronto was approximately $130 million with
166,000 transported patients in 2005. This average will include both fixed overheads and
variable components of costs. However, like fire departments most costs are unavoidable
and therefore an average allocation across all responses seems warranted.) In 2004
dollars the cost per land-based transport by ambulance is $754. We have assumed a value
one-half this amount for transport by the Coroner.
We have no data on the costs for water ambulance service. Given its infrequent
use related to motor vehicle collision we have assumed a cost identical to land based
ambulance services.
A non-profit corporation accountable to the Ontario government provides air
ambulance services in Ontario. Budgets and numbers transported are not available.
However, approximate values provided to us suggest an average cost of approximately
$5,000 per person transported by air ambulance. Given the small number of air
ambulance trips involved we use this figure despite its uncertainty.
7. Tow trucks
Tow truck charges are typically included in insurance claims. As a result we
deduct the amount estimated for tow truck costs in this section from the estimate of
insurance claims payouts. Any uncertainty in our estimate of tow truck costs is netted out
in the calculation of insurance claims costs.
Industry sources suggest that most motor vehicle collisions occur in areas covered
by municipal contracts for tow truck services. These contracts are extremely competitive
and most are “loss-leaders” for tow truck operators. Instead operators of tow trucks
recoup losses on related charges for clean-up, dolly wheels, storage, compound fee, and
TNS Canadian Facts, Social and Policy Research 35