Analysis of costs and utilization of ambulance services in the ministry of health facilities, Malaysia

Abstract

Background Despite emergency ambulance services playing a pivotal role in accessibility to life-saving treatments in Malaysia, there are still numerous gaps in knowledge in terms of their utilization and cost. This leads to current policies on procurement, maintenance, and allocation being predicated on historical evidence and expert opinions. This study thus aims to analyse the cost and utilization of ambulance services in selected public health facilities in Malaysia. Methods A cross-sectional study was employed involving 239 ambulances from selected hospitals and clinics. Ambulance service utilization was based on the number of trips, distance and duration of travel obtained from travel logbooks. A mixed top-down and activity-based costing approach was used to estimate the monthly cost of ambulance services. This constituted personnel, maintenance, fuel, overhead, consumables, ambulance, and medical equipment costs. The utilization and costs of ambulance services were further compared between settings and geographical locations. Results The average total cost of ambulance services was MYR 11,410.44 (US$ 2,756.14) for hospitals and MYR 9,574.39 (US$ 2,312.65) for clinics, albeit not significantly different. Personnel cost was found to be the main contributor to the total cost, at around 44% and 42% in hospitals and clinics, respectively. There was however a significant difference in the total cost in terms of the type and age of ambulances, in addition to their location. In terms of service utilization, the median number of trips and duration of ambulance usage was significantly higher in clinics (31.88 trips and 58.58 hours) compared to hospitals (16.25 trips and 39.25 hours). Conclusions The total cost of ambulance services was higher in hospitals compared to clinics, while its utilization showed a converse trend. The current findings evidence that despite the ambulance services being all under the MOH, their operating process and utilization reflected an inherent difference by setting.

Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia

“…Since ambulances will be replaced more often and ambulances will be utilized more frequently, it is no surprise that both costs would escalate. An ambulance utilization analysis in Malaysia further evidenced that newer ambulances had higher utilization in terms of duration and the number of trips compared to those above 10 years [ 22 ]. Despite 10 years of ambulance replacement approach being the more expensive strategy of the two, the cost-effectiveness analysis reflected the opposite finding.…”

“…The existing ambulance replacement strategy is mainly adopted as an ad-hoc approach, where any ambulance identified as BER will be replaced irrespective of its age. Some ambulances are still in use despite being more than 15 years old and some ambulances were still not replaced despite being in the BER state [ 22 ]. This study also did not include the variability of ambulance services between urban and rural as well as hospitals and clinics.…”

“…This study also did not include the variability of ambulance services between urban and rural as well as hospitals and clinics. Decision makers may want to have a different approach for different geographical locations since the utilization frequency of ambulances in rural facilities differs compared to urban [ 22 ].…”