Australia’s tyranny of distance

Nearly 25% of the Australian public assumes that Medicare does in fact cover ambulance services.3 If Medicare were to fund ambulance services, the base-level taxation would need to increase by 0.3% to cover the costs.4 As a user-pay system, insurance is purchased directly from the ambulance service or as part of individual private health insurance. Only two states offer free service, Queensland and Tasmania.2 State-based ambulance services are organized based on activity: emergency and nonemergency patient transport as well as specialized teams such as rescue and special operations, aeromedical retrieval, and mental health. Nationally, 3.5 million incidents were reported to ambulance services, in which 4.4 million ambulances responded and assessed 3.3 million patients.2 The increase in demand for ambulance services is because of an aging population, changes in social support, accessibility of services, and increased awareness.11-14 "Ramping," whereby no suitable ED bed is available for a patient who arrives by ambulance at a hospital, preventing them from being admitted, remains an issue for many services across Australia.™2'15 The ambulance, with the paramedic and patient on board, is forced to wait outside the ED until the patient can be accommodated.