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Silvana Vargas has chronic acid reflux, but this was different. The pain kept her up all night. By 6 a.m., she decided she needed to go to a hospital.
Her boyfriend had work, so Vargas didn't have a ride. She called an Uber. On the ride over, the pain was so bad she wanted to scream, but she held it in.
"I was trying not to freak my Uber driver out," she said.
Vargas was worried the driver would stop and call an ambulance.
"All that stuff costs a lot of money," she said. "I'm a college student. I don't have time to risk getting a bill."
Vargas made it to the emergency room. The Uber cost $13. Luckily, it was too early for Los Angeles traffic to build up, so the ride was quick.
When she got to the hospital, she learned her condition was serious. Doctors told Vargas she had gallstones and needed surgery immediately.
But if Vargas had to do it again, she'd still take an Uber rather than calling an ambulance.
"I would only take an ambulance in a life-and-death type of thing," Vargas said.
There's no debating that an ambulance ride can be really expensive. A 2012 New York City Fire Department fee schedule posted online sets the price of a basic life support ambulance ride at $704, plus $12 a mile and $60 for providing oxygen. Taking an ambulance with more advanced equipment costs more than $1,100. (Check your health insurance policy to get an idea of how much your insurer will cover.)
Using Uber or another ride-share service can be significantly cheaper. When Dina Waters' neighbor had an asthma attack, she refused to take an ambulance because she was worried about the cost. So Waters called an Uber.
"Mostly it was because she insisted," Waters said. "I probably would have called an ambulance if she hadn't been so insistent. It was making her really frenzied and she already couldn't breathe."
Waters went with her neighbor to the ER. It cost $17. Waters said she's taken an ambulance before, when she had passed out while running. It cost more than $1,000.
Ambulances provide much more than transportation, said Scott Moore, a lawyer and consultant to the American Ambulance Association who has also worked as an emergency medical technician for 28 years. That's why they can be expensive. An ambulance service provides you with trained medical professionals and hundreds of thousands of dollars of medical equipment, in addition to a ride to the ER. They're available 24/7. Plus, reimbursement from Medicare, Medicaid and private insurers is usually less than the cost of providing service, Moore said.
More people are taking Ubers to emergency rooms across the country, according to a study published in December that found ambulance usage dropped by at least 7% in cities after Uber launched. Leon Moskatel, a co-author of the study and an internist at Scripps Mercy Hospital in San Diego, said the effect was immediate when Uber launched in a city.
"Within a quarter, you could see a downtrend on ambulance volume," he said.
The study suggests that more people took Uber when it was available because of the high cost of ambulances. It didn't measure health outcomes or why people chose a particular mode of transportation.
However, there may be other reasons ambulance volume dropped, Moore said. People could be using primary care more and so don't need to go to the emergency room as often. Plus, as Uber has become more widespread over the past few years, so have neighborhood urgent care clinics.
"There's a lot more opportunity for people to get care where they are," Moore said.
Many people probably look at ambulances like Silvana Vargas: only use if you think you'll die. If patients know their condition isn't critical, using a ride-hailing app should be fine, Moskatel, the co-author of the Uber study, said. The problem is that patients aren't always qualified to diagnose their condition.
Patients are generally bad at assessing risk, Moore said. By using a ride-hailing service, they are not only avoiding an ambulance ride, they are also missing out on a 911 call with a trained dispatcher who can provide assistance.
"The tough part when you don't even involve the ambulance service or 911 operator is that you are missing out on a ton of opportunities for care," Moore said.
An Uber driver won't be able to tell if you're going into cardiac arrest or know what to do in that situation. An Uber driver won't know you need to skip the emergency room altogether and go straight to a catheterization lab, or whether the hospital you want to go is the best one to treat your condition.
People taking Uber instead of ambulances to the hospital isn't all bad. If ambulance volume is dropping, that means more ambulances are available when people really need it, Moore said. Moore hopes the study sparks dialogue about the cost of ambulance service.
If people are indeed taking ride-hailing services, it's important that patients are educated on when they need to take an ambulance and when other transport is appropriate, Moore said. When in doubt, he said, you should call 911.
This is Uber's policy.
“We're grateful our service has helped people get to where they're going when they need it the most," a company spokesperson said in a statement. "However, it's important to note that Uber is not a substitute for law enforcement or medical professionals. In the event of any medical emergency, we encourage people to call 911.”
Future studies should look at how ride-hailing services can be part of an emergency response policy and how the advent of these services affects health outcomes, Moskatel said.
"I think there's a role for ride-sharing in making sure the appropriate person gets to the appropriate location," Moore said.
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