Thank God, I have never seen an ambulance from the inside. It is rather rare that one hears the siren of an ambulance in our neighborhood: the little town I live in has a population of 4,500. The area of the town is large but the houses are far from each other because the town is located in a watershed area: lots of forests, brooks, lakes, rivers, and few people. When a couple of years ago an ambulance came to our road we all knew that there had to be something very wrong with Mac, one of our neighbors. And indeed, he had had a stroke. Luckily it was a fairly mild one and he more or less recovered except for slightly slurred speech.
But even in the nearby larger city when an ambulance, siren wailing, navigates traffic, we may not know the patient but we do know that he is in rather serious condition. If he were just not feeling well, a relative, a neighbor, or a friend would take the person to the doctor or to the emergency room in a car. Running an ambulance service is an expensive affair and most insurance companies (including Medicare) pay for ambulance transport only if there is a real medical reason. Medicare, for example, is explicit about when one can expect payment for an ambulance ride: "When you need to be transported to a hospital or skilled nursing facility for medically necessary services, and transportation in any other vehicle would endanger your health."
This is the situation in a country infinitely richer than Hungary, where a much higher percentage of the GDP goes for healthcare. In Hungary, an ambulance, at least until now, was often used as a convenient mode of transportation to and from the hospital or the doctor’s office. Let’s say someone had an operation in the hospital and was ready to go home. Even if the patient had a relative, friend, or neighbor who was willing to take him home, he had the right to be driven home in a fully equipped ambulance. Or if the patient went to a doctor’s office and the family physician decided that he needed further tests or he had to check into a hospital, the doctor simply called an ambulance.
Can you imagine that? I can’t. Well, this "horrid" ministry of health can’t either, and at last they decided to do something about it. From here on, similarly to the situation here, an ambulance will be used only if it is medically warranted. (I may add here that some of the Hungarian ambulances also have full-fledged doctors on board instead of paramedics only.) The ordinary "transportation of patients" will be done by private companies and their vehicles will be regular cars or vans. I still find this quite luxurious considering that the insurance companies here don’t provide such services.
Olga Kálmán’s program on ATV today will perhaps illuminate the thinking–which I consider rather peculiar–in Hungary. The spokesman of the Hungarian ambulance service explained that from here on the doctor will have two different forms: one for ambulance service and one for ordinary patient transportation and he will decide which one is appropriate. If I had been Olga Kálmán, I would have been satisfied with this information, but not Olga. She came up with the following hypothetical: "What if the doctor decides that ordinary patient transportation will suffice but on the way to the hospital the patient suddenly becomes very seriously ill and after all he does need the services of an ambulance? What will happen then?" The spokesman for the ambulance service explained that in this case the driver of the van will call an ambulance. But, said Olga, "Isn’t that dangerous? Precious time is lost!" Only in a country where the healthcare system until now paid no attention whatsoever to cost would such a comment seem normal.
Olga Kálmán wanted to have some figures on how much money can be saved by this "revolutionary" change in ambulance service. The spokesman had no hard figures but gave an example. In a smaller town there are two ambulances. These two ambulances do nothing else all morning but collect patients from the nearby villages and take them to the doctors or the hospital. If they are lucky they are finished by noon. I don’t think that higher mathematics is needed to figure out the cost and the resulting savings.