Strengthening Emergency Care through the Provision of Ambulance in Public Health Facilities: Economic Issues and Policy Implementation Guidelines

Provision of ambulance services in remote areas is an important policy intervention to strengthen the referral system and improve the quality of emergency care. The financial requirements resulting out of capital costs and operating expenses are huge. Given the financial constraints facing the State Governments in India, the departments of health need to explore alternative options. In this paper we discuss the options of leasing or hiring of vehicles. We also examine that if the facility has to self-sustain, what should be user-fees charges from the users of these facilities. However, we discuss policy implementation issues of protecting poor from high burdens and suggest an overall cap on total charges and exemption indigent patients. The role of local governments such as panchayats in creating contingency fund to meet the needs of the poor and developing appropriate exemption policy is considered inevitable to sustain these facilities.