Universal access to ambulance does not increase overall demand for ambulance services in Queensland, Australia

Objective. To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. Method. The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. Results. QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean≤149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. Conclusions. The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program. What is known about the topic? It is generally well accepted that the demand for emergency health services is increasing however the drivers for demand are poorly understood. In Queensland in particular, growth in demand for services exceeds that seen in other states and territories. Some commentators have pointed at service funding policy and costs to end users as potential reasons for excess demand for services. What does this paper add? The assumption that forced subsidisation creates a perception of entitlement amongst consumers is challenged in this paper. We are able to demonstrate that demand for emergency health services did not increase beyond what would have been expected under a mandatory subscription system known as Community Ambulance Cover (CAC). This paper contributes to the developing body of knowledge about drivers for emergency health service demand. What are the implications for practitioners? There is a need to continue analysis of the system to determine drivers for demand and develop an evidence base on which to formulate emergency health policy, including funding models, for the future. Purely economic drivers for service demand seem unlikely to hold up and policy makers need to understand the complex relationships between service systems; end user perceptions and health literacy; and the costs of services in order to effect policy reform