Evaluating Financing Options to Strengthen Ambulance Services

The provision of ambulance services in remote areas is an important policy inter vention to strengthen the referral system and improve the quality of emergency care. The financial requirements resulting out of capital costs and operating expenses are considerable. Given the financial constraints facing state govern ments in India, departments of health need to explore alternative options. In this article we discuss the options of owning, leasing or hiring of vehicles. We also examine that if the facility has to be self-sustaining, what should be the fees col lected from the users of these services. We also discuss policy implementation issues of protecting the poor from high financial burdens and suggest an overall cap on total charges and exempting indigent patients. The role of local govern ments such as panchayats in creating contingency funds to meet the needs of the poor and developing appropriate exemption policies is considered important to sustain these services. The approach suggested in this article is an illustrative one and results would change depending on what numbers are used in analysis. These numbers are also expected to change from situation to situation. The spreadsheet used in this analysis can be obtained from the author on request.