Healthy Communities / Research

Regional Differences in Ambulance Service Ownership and Management

By Su Troske and Sookti Chaudhary

Emergency care for an individual often begins when Emergency Medical Technicians (EMTs) and/or Paramedics arrive in an ambulance. Communities must find a way to provide this essential service to their residents. Federal legislation has allowed communities flexibility in determining who provides ambulance services. We define 5 models, or ownership types of ambulance services among U.S. communities:

Fire Department: Non-profit, Fire Department-based EMS Service.

Community, Non-Profit: Owned by a “Community”, not-for-profit meaning patients likely pay for the services through taxes, like fire protection and ambulance tax districts.

Governmental, Non-Fire: Owned by a “Community” and only offers EMS services, not fire service.  Community-owned ambulance companies are included in this type.

Hospital:  This is a service managed by a hospital. Ownership type of the hospital can vary such as non-profit or for-profit.

Private, Non-Hospital: Privately owned (for-profit) and not owned by a hospital.  Examples are Gold Cross or AMR companies.

CEDIK has access to the National EMS Information System (NEMSIS) data for year 2010-2015, which provides the most comprehensive data available on 9-1-1 ambulance calls. Below are a few preliminary findings from the NEMSIS data on the different ownership types of ambulance services and regional variations in usage.  It is important to note that we focused on 9-1-1 calls with an ambulance transport to a hospital for Medicare-aged patients.

From 2010-2015, the calls serviced by ownership types have remained fairly consistent. Figure 1 shows the percent of total calls in a year serviced by different ownership types. For example, 27% percent of 2010 calls were serviced by Fire Departments. In most years, Fire Departments provided the most 9-1-1 call transports.  In 2015, while Fire Departments covered almost 30% of the calls, calls serviced by Private companies represented 25% of the calls. The fewest calls were handled by Hospital-based services at 12%.2010-15_911_calls_by_ownership type

After understanding which services were most frequently used in 9-1-1 call transports, we looked next at regional differences in the NEMSIS data. Figure 2 below shows the difference in call volume by ownership type for the East South Central Census division, compared to the rest of the United States. In the East South Central division (which includes Kentucky), 64% of its calls were serviced by Private, non-hospital ambulance services. The states that make up the East South Central region are Alabama, Kentucky, Mississippi, and Tennessee. These four states rely more on private ambulance companies for service.


The Kentucky Board of Emergency Medical Services (KBEMS) confirms that for Kentucky, much of the state relies on the private, non-hospital ambulance services in recent years. The national conversation on healthcare has not been talking much about reimbursement for ambulance services. Given the regional differences in ambulance service ownership and management, if changes are made to the reimbursement structure at the federal level, there will be regions that are impacted more than others.

In future work, we are continuing to analyze the NEMSIS data to understand patient, ambulance service and incident characteristics which affect ambulance call times by ownership type. Ultimately, we wish to explore how the ownership models affect health outcomes among community residents.

We thank John H. Schnatter Institute for the Study of Free Enterprise for financial support.  The opinions expressed reflect the views of the authors and may not represent the opinions of the Schnatter Institute or the University of Kentucky.


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