Traditionally, the policies and strategic planning of EMS have focused on implementing approaches based on making tradeoffs. The approach is informed by economic argument in the health sector where resources are scarce and demands are unlimited. The observation calls for sound policies and strategic plans that address needs with the most significant impacts if not resolved. Policy makers must thus be able to rank the interventions as well alternatives. The perspective is a cost-benefit model that focuses on getting the best from resources utilized as well as reducing wastage.
The economic arguments have informed policies and strategic plans behind the design of public-utility EMS models (PUMs). The 1970s postulation was proposed economists and behaviorists from University of Oklahoma who were working under a Kerr funded-Health Policy Research Team (Bledsoe, 2003, p.1). The scholars believed that treating prehospital care as a public utility was an effective way of containing moral hazard associated with services with higher elasticity of demand such as EMS. The model has been found to be effective in balancing between economic efficiency and producing sound advanced life support prehospital care. One of the scholars behind the model, Jack Stout, argued it was a high-performance model as it did not only cushion prehospital care against possibilities of market failure but also moral hazards. It also resolved fear of unhealthy competition at retail level and improving competition at wholesale level (Stout, 1980, p.38).
Despite its economic efficiency and huge support by the public, the adoption of PUMs in the ambulatory services over years has exposed its ineffectiveness in service delivery (Stout, 1985, p.56). Its focus is promoting accountability and good utilization of resources rather than delivering high quality services (Bledsoe, 2003, p.2). The model does not also recognize population-specific needs such as politics, size, geography, and demographics that should inform service delivery propositions (NHTSA, 2008, p.3). Rather than looking at economic performance only, the EMS policy-making process, strategic planning, and assessment should also address both intrinsic and extrinsic factors as well as sustainability and effectiveness.
Bledsoe, B. (2003). EMS mythology. EMS myth #8: Public-utility models are the most efficient model for providing prehospital care. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 27 September 2015, from http://www.ncbi.nlm.nih.gov/pubmed/14596041
NHTSA,. (2008). Configurations Of EMS Systems: A Pilot Study (1st ed.). Retrieved from http://www.ems.gov/pdf/810911.pdf
Stout, J. (1980). HPEMSP III: The Major Constraints (1st ed.).
Stout, J. (1985). Public utility model revisited, Part One: Origins. JEMS, 11(2), 55-63.