Did UberX Reduce Ambulance Volume?

We study the effect of Uber market entry on per capita ambulance volume. An ambulance ride can easily exceed over a thousand dollars, usually with great surprise to the patient. Insurance often only partially covers the expense or outright refuses to pay for transport deemed not medically necessary. Individuals often lack another means of transport and would use one if one existed (Billittier et al. 1996).

Many have now started to seek alternate, cheaper transport to the emergency room in the form of ride-sharing services such as Uber and Lyft. In addition, while ambulances typically route to the closest hospital, ride-sharing services allow the patient to choose to which hospital they present, a potentially important factor as these facilities may have differing results for the same illness, with higher-cost hospitals associated with better outcomes (Doyle, et al. 2015). Cities have noticed enough residents making this shift that they have discussed how these ride-sharing services could be integrated into their EMS frameworks.

We use quarterly 2013-2015 dates of Uber entry into different US markets from the Uber Newsroom blog and external publications. Ambulance rates were obtained from the National Emergency Medical Services Information System (NEMSIS). Our regression follows a generalized difference-in-differences framework at the city-quarter level. We have 797 city-state groups, splitting cities that cross state lines into two units.

Across a wide variety of specifications, we find a 7% decrease in the per capita ambulance rate from Uber entry into a city. Given that even a reduction of a few minutes can drastically improve survival rates for serious conditions (Pell et al. 2001), this could be associated with a substantial welfare improvement. Additionally, consumers substituting to a cheaper alternative when possible would free up resources to be spent more efficiently.

One other possibility is that Uber market entry reduced the need for ambulances due to reductions in auto accident related fatalities (including those involving alcohol). Given the mixed literature on Uber’s impact accidents, this will need to be investigated further by future researchers (Brazil and Kirk 2016; Dills and Mulholland, 2017; Greenwood and Wattal, 2017).

Overall, our results suggest that Uber entry into a city has positive impact, decreasing ambulance usage.

References:

Billittier et al. (1996). A Multisite Survey of Factors Contributing to Medically Unnecessary Ambulance Transports. Academic Emergency Medicine, 3(11): 1046- 1052.

Brazil, N, DS Kirk. (2016). Uber and Metropolitan Traffic Fatalities in the United States. J Epidemiol, 184(3): 192–198.

Dills, AK, SE Mulholland. (2017). Ride-Sharing, Fatal Crashes, and Crime Available at https://ssrn.com/abstract=2783797.

Doyle, JJ, JA Graves, J Gruber, SA Kleiner. (2015). Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns. Journal of Political Economy, 123(1): 170-214.

Greenwood, BN, S Wattal. 2017. Show Me The Way To Go Home: An Empirical Investigation Of Ride-Sharing And Alcohol Related Motor Vehicle Fatalities. MIS Quarterly, 41(1): 163-187.

Pell, JP, JM Sirel, AK Marsden, I Ford, SM Cobbe. 2001. Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study. BMJ, 322(7299): 1385-1388.