End the ambulance monopoly in Riverside

Riverside policy should seek the best, most cost-effective ambulance service for residents, not perpetuate a de facto monopoly.

Published: September 17, 2013; 06:16 PM

Riverside’s ambulance policy should focus on providing the best, most cost-effective service to residents. Perpetuating a de facto monopoly is the wrong way to reach that goal. The City Council should abandon a policy that looks suspiciously cozy to one provider and let market competition work in residents’ favor.

The Riverside City Council plans to hold a workshop on the ambulance issue, probably later this month. Mayor William “Rusty” Bailey calls the city’s current policy “antiquated,” and has wanted to revisit the topic since the city’s last discussion nearly two years ago.

Rethinking the policy is a good idea, because the city’s approach to ambulance service is highly questionable. Most cities allow ambulance companies to provide nonemergency transport, such as from a hospital to a nursing home, as long as they have a business license and a permit from the county. Riverside, however, uses a system of franchise permits. Theoretically, any qualified ambulance company can apply for a permit to operate in Riverside, but in practice the city has rejected applications from all providers but American Medical Response, or AMR. The city’s jurisdiction extends only to nonemergency transport; Riverside County oversees emergency ambulance service.

But Riverside’s exclusive arrangement with AMR rests on several suspect premises. City code says that ambulance companies seeking a permit must show that there is a public need for the additional ambulance service. The city rejected two ambulance companies’ applications in late 2011 on the basis that there was no need for ambulance transport beyond what AMR was providing.

Yet the head of the state Emergency Medical Services Authority said in early 2012 that Riverside lacked the authority under state law to use “need and necessity” to limit ambulance providers. And in any case, the fact that the current provider is acceptable says nothing about whether additional companies might improve service, or shrink the costs that patients pay through their health insurance.

City code also requires consideration of whether additional ambulance companies in Riverside would “impair the economic viability of the existing franchisee.” But that hurdle is nearly impossible to overcome, because letting another ambulance company into the city is bound to “impair” the existing monopoly. Besides, there is no public interest in protecting a private ambulance company from competition.

The city in 2011, in fact, never bothered to compare ambulance costs in Riverside with those in areas that have competitive service — an analysis that should have been a central focus of the discussion. Surely, the price of nonemergency transport, which can easily run $1,000 or more a trip, is a matter of direct interest to Riverside residents.

Riverside’s approach only invites uncomfortable questions about whose interests city policy puts first, or why the city would prevent competition from cutting costs and improving service. Other cities manage just fine without such a restrictive approach to ambulance companies — and so should Riverside.

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