This is a bit of a surprise, seeing this Volvo-based ambulance, which Corey Behrens shot on the street in Stockholm, Sweden. I just assumed all European ambulance are van-based. It’s so compact and light compared to what goes for an ambulance hereabouts. As is the cost for a ride to a hospital in Stockholm compared to Eugene.
Our current ones in Eugene have a Ford F-450 chassis, a medium-class truck. What all is in there? A full operating theater?
FWIW, a ride to the hospital in Eugene will you back $1859.00 and $24.18/mile. And yes, they will charge you that and come after you with their collection agency and get a judgment against you if your insurance doesn’t cover all of it.
I’ll drive myself; thank you. I can drive with one arm. Or ask Stephanie or a neighbor. Better yet, I’ll just not go at all. I’m a great DIY physician. You think I went to the Emergency Room when I shot a framing nail with a nail gun through my finger. Nah…fortunately, it didn’t hit a bone.
Last time I was a patient in a hospital was…1978. And that was utterly unnecessary surgery; I should have sued for malpractice; I want my foreskin back. It least he didn’t botch it.
No wonder we had home births for our three kids; the last one I delivered myself.
The cost of an ambulance ride in Sweden? 150 kronor. That’s $16.51 USD. Obviously that’s heavily subsidized by the government health care system, but I bet it doesn’t cost them any stinking two grand, even if it is a Volvo and not a Ford Transit.
OK; this was not intended as a troll on the very sick (but financially very healthy) American health care industrial complex. My apologies. But seeing this Volvo triggered something in me, like this memory: When Stephanie and I were in Austria in the winter of 1980, I came down with bronchitis. We were staying with my aunt. She called the doctor, a lovely woman who showed up at her apartment later that same day to check me out and prescribe some antibiotics. I’m struggling to remember if I was asked to pay some very nominal amount or not.
Enough of all that. There’s no need to get into some stupid pissing match in the comments about this. It’s just the way the system is, and it’s not going to change drastically anytime soon. Maybe some small incremental fixes, like Obamacare and the expansion of Medicaid. We’ve created a monster that costs us twice per capita compared to Europe, with no better outcomes. The contrast can be seen in this Volvo and that F450 ambulance. They’re just two relatively minor but very representative examples of two very different approaches.
I think in Sweden they have always used Volvo-based ambulances. I remember 240/260 ambulances. In Denmark we did use the W124s in the eighties, but it’s all vans now – Mercedes Sprinter mainly but all that size.
I’m surprised it costs anything to call an ambulance in Sweden if that’s the case. It’s 100% covered in Denmark. The American prices cited are to Scandinavians absolutely absurd.
And that’s not to say the Dansih healthcare system is perfect – far from it but I have yet to meet a Scandinavian who would not want universal healthcare.
Mads Jensen, nice to see a comment from a Dane here.
When my 3rd X-wife and I were on our honeymoon to Finland and Denmark, I came down with a case of Bronchitis while we were staying in a hotel in Copenhagen.
Having been a citizen early in life, I thought I might be best treated at a hospital. So I walked into a local one and asked for assistance. I got checked in, waited a little and was soon seen by a doctor. He examined me, wrote a prescription and released me to leave. When I asked where I go to pay, he just laughed. He told me “There is no place to pay in this building” I was told thank you for coming in and just be on my way. I don’t know if it is still the same, that was 34 years ago. The system really worked well in the Scandinavian countries where this sort of social medicine system is administered. I had the same result in 1947 when I had a ruptured appendix and was cared for at Bispebjerg Hospital. I had the surgery and my mother just signed me out, nothing to pay.
Very interesting Volvo ambulance for sure! I have done some work for government agencies and without wading into any political comments, as far as the vehicles go: I think the USA-style ambulance bodies and all their internals are mostly required by Federal law.
They also have to be retired after certain age/mileage parameters. That’s why you see so many ex-ambulances still running around (with the box, or with some other body attached) for landscaping companies, paint contractors, etc. At least we do in the Southeast, where salt is not an issue. The mechanicals are still good and they were probably well-maintained, they just hit the retirement threshold.
You can see how that would cause an ambulance ride to be an expensive proposition, along with a lot of other factors up for debate, for sure.
For what it’s worth, an ambulance ride in rural NC in a county EMS unit is about $400. Not cheap, but cheaper.
The same issues come into play with public transportation, as an aside. The Federal government spells out vehicular requirements, and what vehicle runs on what type of route. The drivers also cannot TOUCH a passenger.
So, if you walk with a cane and have trouble getting onto a bus without help for a trip to the doctor, maybe just because of a temporary health problem, you have to call for “medical transport”. That might be a Chrysler 300, it might be a minivan, it might be a handicap van, it might be an ambulance, depending on your situation. Medicaid will pay for that (if you are eligible) and it is astronomically expensive, compared to a bus ride. But, the medical transport drivers CAN touch you, help you in and out of the vehicle and your house, etc.
There’ll be those that tell you the “imported luxury car ambulance” clearly costs more than the humble pickup truck with a box on back and doesn’t need to be so fancy… Gage and DeSoto wouldn’t know what to make of it, same as Leif and Lars can’t imagine the F450 in downtown Stockholm.
The pricing likely beats that of an Uber ride if the hospital is near the club, that’s the problem we’d have here. But all kidding aside, as much as I can’t stand Uber and the like, an unintended benefit of the service seems to have resulted in much faster and critically cheaper transport to medical institutions for those dependent on others to get them there.
Around here it’s mostly Sprinter vans with the occasional Transit and maybe one or two of the older style boxes, usually grafted on to a Sprinter cab chassis though. Or at least those are the ones I notice. The fire department probably owns some sort of F450-like device to do similar duty I guess, but in town it’s mainly private companies and ones owned or contracted (certainly branded as such) by the local hospital systems themselves.
Nice looking piece of equipment.
Our ambulances are normally Mercedes Sprinter, Ford Transit or IVECO Daily based – larger than this XC90 conversion but more compact than the F150.
First responders may arrive in an estate car with bags of kit inside – typically a Skoda Octavia, Superb or a Mondeo. Rural areas may use a Discovery Sport or similar. No patient carriage but quicker to arrive than an ambulance. 4 minutes in my case.
No ticket purchase required.
F150? These are F-450s. A whole different thing.
I never fail to be amazed [and at times even shocked] at the differences in medical costs and billing practices in various countries.
In 1970 my Grandfather was visiting the Kremlin complex in Moscow, when he slipped on icy steps and fell down a set of stairs. He was rushed to the hospital and stayed there for 3 days. He said not only was the treatments as up to date as what he had received in America, but every doctor he dealt with spoke English.
On his discharge, he asked how they wanted him to pay the bill, because as a senior [retired] Federal government employee, he had full insurance. He was informed there was no charge, he owed nothing, that everyone in Russia had a right to free medical care.
Compare that to today: Just this past summer my girlfriend Pepper was visiting friends a couple of miles over the state line into Delaware, when she cut her hand. An ambulance was called and she was taken to a huge medical complex in the Wilmington, DE area. Her Maryland medical insurance covered everything except the Ambulance ride. The bill from the [for profit] ambulance company was over $3,100.
As I handle all the bills for the 3 of us, I sent all the insurance info to the ambulance company. They said they don’t process out of state insurance company paperwork, I should file to get reimbursed. Again they claimed I needed to pay the bill immediately, as after 30 days they send it out for collections. And someone hand wrote, using a RED ink sharpie type of marker pen, in large letters, the message; “If not paid in full within 30 days of mailing, we WILL come after you.”
I have a family member who is an attorney, so a phone call was placed. We all felt that hand written statement, in heavy red marker, could be interpreted as a threat to do bodily harm. He said under Maryland law, what he saw in that bill was indeed a threat to do bodily harm. And since the bill was mailed to a Maryland address, it could be dealt with in the Maryland court system.
He sent a letter of intent to the Ambulance service, notifying them of a pending lawsuit for illegal threats to both Pepper and I. He pointed out that under federal law, because Pepper’s insurance is under Social Security Disability [SSI], they are required to accept the SSI insurance, managed by the State of Maryland. Under the law, if they don’t choose to accept the SSI, they cannot send a demand for payment.
This past Wednesday I checked our PO box, and there was a letter from our attorney. He said the ambulance service submitted a claim to Pepper’s insurance company, and the allowable amount was paid: $262.84. There is no co-pay, that’s all they get.
And the last comparison;
I have long time friends who live in England. He ran a garage, she worked for a large international book publisher as a manager of their accounting department for England. About 25 years ago she developed a large lump on her throat. It was determined to be a tumor that was still growing and needed to be removed. Under the national medical system, the soonest she could get the surgery performed was almost 2 years away. There was a concern she could die before the surgery.
I pointed out that her employer had a major facility in the USA. I asked if she might get a temporary assignment to the USA facility, get on their insurance coverage, and schedule the surgery. A couple of months later, she had the surgery done in the US, and flew back to England.
That ambulance tale is,to an European, almost completely unrecognizable
The biggest stumbling block [in my opinion] is “State’s rights”, where each of our 50 states controls their local medical issues like hospital services and ambulance services. We do have a similar system in place for federal insurance, but it’s for those above the age of 65 [but it can be accessed at age of 62 for lower benefits] and certain types of disabilities.
Delaware has always been more interested in the corporate world, and has not done well in taking care of citizens needs when compared to other Mid-Atlantic states. Here in the adjoining state of Maryland, ambulance services are very regulated, and rarely result in a patient having to pay, unless they do not have insurance. We have state police emergency rescue helicopters that, if called in by the state police, are still a free ride if you don’t have insurance. [Example; a vehicle crash where transport to the hospital for a victim deemed to require critical lifesaving care.]
Alongside their fast response ‘first responder’ cars, Volvos have also been used as full ambulances by various UK regions as well. Such as this beast of a V90 conversion. Thanks to the NHS though, it’s a free ride for us…..
I suspect the “long nose” ambulances either reflect some longstanding local tradition, or are the result of bloat that pushes the body and equipment weight way over the limit for a Sprinter/Transit/ProMaster type van, even an E Series which is still available as a chassis cab. Otherwise I don’t understand why any driver would want that extra hood length over a van. Even rural areas have tight driveways, etc where maneuverability would help the crew. However, I think I saw similar rigs in Quito, Ecuador (both Ford and Ram based) which has incredibly narrow streets and heavy traffic. The Volvo is nice … would make a great camping vehicle too.
Those ambulances you saw in Ecuador were almost certainly used American rigs. There’s a good market for them in Latin America and South America.
I think it is mainly due to weight of the patient care box and all of the equipment that they have moved to Medium Duty vehicles. Yes the E-450 is still available but the diesel option was dropped several years ago and I think that has hurt their popularity.
If you ever need to be air-lifted to a hospital, you may request a seditive, then a push out the door. The bill for this service will kill you with a heart attack anyway.
The Rettungswagen in Germany are more like the American ambulances based on Mercedes-Benz Sprinter cab chassis with custom-built box attached. The ambulances based on wholly on Sprinter delivery vans are often used as the support vehicles. The car-based ambulances are very rare in Germany nowadays.
The ambulance service is free since the entire cost is covered by the gesetzliche Krankenkasse (statutory health insurance). In some situations, they are accompanied by the Notarzt (emergency doctor) who drive the passenger cars (usually estates) or SUVs. They are sometimes first to arrive at the scene before the ambulances.
My uneducated guess is that Swedish ambulance is less of an ambulance in the American sense and more of a medical transport. Federal and state laws are pretty strict on what equipment ambulances need. Federal, for instance:
CFR § 410.41 Requirements for ambulance providers and suppliers.
(a) Vehicle. A vehicle used as an ambulance must meet the following requirements:
(1) Be specially designed to respond to medical emergencies or provide acute medical care to transport the sick and injured and comply with all State and local laws governing an emergency transportation vehicle.
It’s the acute medical care that drives up capital and operations costs. The F-450 is a rolling ER. Maybe that relatively small Swedish ambulance has the same capabilities as the F-450, but I’m guessing not.
I’m a medical doctor i denmark, but I’ve been riding along car based 4×4 ambulances in Sweden some 10 years ago. They managed to drive very fast in snowy conditions, sometimes the driver had fun drifting through corners.
Never seen the Americans from the inside, but I remember the swedish ambulances as fully equipped, as are the ones we use i Denmark, but the work space is quite limited. General population is less overweight I believe, but we also have special ambulances now for patients weighting over a sertain limit. Those i think are truck based. Ambulances are mostly for stabilizing treatment untill you reach to hospital, so no need for full ER’s.
To my knowledge the expenses for ambulances here average at less than 500$ per call.
Aha! The obesity crisis strikes again. That explains it very well. Thank you!
If things get worse in that regard, they’ll have to resort to genuine HD trucks.
I wonder what kind of vehicles are used in the South Pacific islands?
That would be a CC job for Johannes Dutch, I’d love to see such an ambulance.
And by the way, thanks for hosting this CC site! Been following for many years with great joy!
Yes, of course! With five axles, four of them steering!
My pleasure. It’s always good to hear from readers for the first time.
Actually, without being sure, I could think the reason for larger ambulances isn’t direct due to the patients weight, but because the stretcher/bed is getting wider.
I think I’ll ask one of the drivers at work…
Kidding aside, it’s a Volvo FL Ambulance-MICU (Mobile Intensive Care Unit). Top speed 130 km/h, BTW.
What a beast!
In Australia we used to have vans based on F250s, and before that Chrysler Royals, but now they fit all the goodies into Sprinter vans.
It pains me to read the many tales of the burden of expensive American health care. Many Canadians look upon the burden Americans face with shock and sympathy. Our system of socialized medicine, while imperfect, is treasured. The person most influential for the system’s creation, Tommy Douglas, is universally admired, nationwide.
From the top photo, comparing the driver compartment to the boxy rear 2/3 of the ambulance, note how much interior volume is wasted by the broad “shoulder” and tumblehome of the donor Volvo. Reduced interior space without any reduction in footprint.
Australia has universal free healthcare (there’s also a big private system if you choose to pay insurance), but one rather weird quirk is that in my State, the State-run ambulance service is NOT free. Annual coverage is only something like $80, and you’re covered without charge if you’re poor or an aged pensioner, but if none of that applies, you will get a bill.
Diesel Sprinters are the main units, along with a number of smaller vehicles for different applications, (right down to BMW off-road motorbikes). I’ve been for a ride in a Sprinter as a patient: unsurprisingly, I felt about as comfortable as a sack of spuds bouncing off to market in the back of a delivery van.
I think I’d prefer this Volvo – or better still, not to be patient in the first place…
Without getting into the virtues of either or any of the multiple systems, this
“Under the law, if they don’t choose to accept the SSI, they cannot send a demand for payment.
This past Wednesday I checked our PO box, and there was a letter from our attorney. He said the ambulance service submitted a claim to Pepper’s insurance company, and the allowable amount was paid: $262.84. There is no co-pay, that’s all they get. ”
gets to me. They knew what they were trying to do was not legally enforceable, but they were trying to anyway as there was no penalty if they lost, but a huge bonus if they won.
And yes, current US ambulances are rolling ER’s. Fantastic if you have a heart attack, not so good if you break a leg and need transport.
In 2007, I injured my left knee when I was at an inpatient physical therapy facility after serverly injuring my right knee. I had an appointment at the orthopedist the next morning, and it was decided that I would just be taken there, as planned, and whatever happened would be dealt with. So they took me to the doctor’s office, after a quick check, it was obvious I had torn my left quadriceps tendon completely off my knee, and would need surgery. At the hospital next door to the doctor’s office. IF I had been taken back to the other side of town, it would have been $169 for the trip. Over 7 miles. But I was taken less than 300 yards to the hospital next door, and the ride was….$985. I had to pay $485 out of pocket. I thought, “It’s got to be a mistake!”. Nope. I ended up agreeing to pay $50 a month on several bills at one time, and after about 10 payments of $200 total a month, they sent me letters saying they had been written off, so I was finally done with paying on the whole deal. A friend recently had bypass surgery, and the bill for the surgery and 4 days in the hospital, was just short of $500,000. Insanity seems to be the word in this country!
Mercedes E-class wagon-based ambulances were a common sight in Stockholm during my time there. I saw a couple of them in action, and I found them fascinatingly different, while Swedes found them to be an utterly normal everyday sight.
They reminded me of the Cadillac ambulances and hearses that were widely used into the 1960s. Perhaps someone should make a Volvo ambulance into a Stockholm Ghostbusters car.