Comment by cepp | Hacker News Reader

Comment by cepp | Hacker News Reader

Back when I worked at $HEALTHCARE_INUSRANCE_CO we were trying to solve this (more general problem) from the other side. We regularly saw routine calls for what could only be described as "loneliness". Our research lead us to find that a high percentage of elderly folks (50+) identified as lonely regardless of their living situation. [1]

Looking deeper into claims data, we found a high percentage of these calls were in rural communities. These inessential emergency calls often lead to resources being expended without need. For example: the singular community ambulance being dispatched to the caller's home only because they wanted to chat. Even when considering the dispatcher filtering out these callers, and the emergency personnel doing their best to leave as quickly as possible, it still places a strain on the system. Tying up emergency personnel with mundane tasks creates a far greater risk for the community if & when they're needed.

We unfortunately found no solution to this problem. It ran deeper than just alleviating non-emergency emergency-response claims: it was due to the loneliness epidemic, and the company was uncomfortable shouldering the financial and legal cost of trying to create a solution.

1. https://www.aarp.org/personal-growth/transitions/info-09-201...

I used to volunteer with an organization that pairs people with lonely “elders”... kind of like a Big Brother/Big Sister program. The woman I was paired with was in her early 60s and went to the doctor constantly but there really wasn’t anything wrong with her. It took me a long time to realize she would go to all these appointments to give her something to do, some people to talk to, and sometimes as an excuse to get her (out of state) kids to talk to her on the phone a bit.

I’ll never forget when I was visiting her and realized she was looking forward to an entire day of medical testing appointments. At fist I thought maybe she had Munchausen’s (and maybe, in a way she did) but mostly I think she was just lonely.

One's early 60s aren't even that old.

An individual living in an isolated rural community wanting a chat is almost entirely unlike a for-profit corporation running a group home calling a paramedic to change someone's bandages because they are cutting costs by not hiring sufficient staff.

  "because they are cutting costs by not hiring sufficient staff."

Or because the fire department has failed to implement something as basic as a call-out fee for frivolous calls. Of course a service is going to get over-subscribed and abused if the price for it is way too low. Both individuals and corporations will do that because it follows from the incentives provided to them. Lonely old people are going to sit on a public tram for 8 hours a day, taking up the space of legitimate travellers, because it's free to do so and the value they get from that is greater than $0. The same over-subscription is happening here with care homes.

If this is an ongoing problem and such a simple fix hasn't been implemented yet, the blame is solely with the incompetence of the fire authority for not having corrected the incentives with a call-out fee.

> call-out fee for frivolous calls

Sounds like a typical neoliberal "free market" non-solution.

This snarky reply isn't a rebuttal of any substance. A frivolous call-out fee is a clear and simple solution. If you fix the price then the problem goes away because the incentive for the frivolous call-out no longer exists. It's cheaper for them to hire another staff member than rely on the fire department.

A fee to commercial facilities making frivolous calls could be more reasonable, as they should have competent folks managing things. See my sibling comment regarding fees in general.

No really. Turning a public service into a fee-based means-tested public/private program is the basic neoliberal program. The polices are always put forward with the rubric that the so-called free market is the best way to solve problems of distribution and fairness. To used a tired example, https://www.villagevoice.com/2010/10/11/libertarian-fire-dep...

I'm not disputing that it's a neoliberal solution, I'm disputing the claim that it's a non-solution. If you charge a sufficient amount for frivolous calls from private homes then private homes will stop making frivolous calls.

It's not a solution. The problem is that emergency services aren't always available to those who need them; if you attach the possibility of a fee to the service then you have ensured that problem exists forever.

Many places outside the US have a fee associated with call outs (Australia), not even just frivolous call outs, and there's no issue.

Ah yes Australia, that noted bastion of equality where there is definitely no social underclass.

The problem of availability already exists because emergency services are abused on non-emergencies this stops those abuses freeing it up for real emergencies, no person no-matter how poor is going to balk at using an emergency service on an actual emergency cuz maybe they get charged 5 bucks if its not "emergency enough"

If it's 5 bucks then it's not going to stop care homes calling them either. If you look at the numbers being thrown around in these discussions we're talking about maybe 5k or more, which can definitely be a life-changing amount for a poor person.

Then don't fine poor people. Fine private care homes only as was suggested elsewhere in this thread. In the article it explains that they're only considering a fee for facilities, not for individuals.

> Then don't fine poor people

Means-testing for public services? Please no. Means testing introduces bureaucratic hurdles, and the cost of determining and enforcing means limits can be up to 10x the actual amounts paid out. https://www.theguardian.com/social-care-network/2013/jan/14/...

I dislike means testing as much as anyone, but a simple test of "are you a private business/facility with more than 1 employee" is one that I could get behind due to its inherently low bureaucratic overhead.

I think there are a lot of potential problems charging a fee for emergency service calls. Who decided what is frivolous?

The person making the call can't be assumed to be an expert. And in many cases, it might seem serious/freaky in the moment, but be less so to an outside observer.

This sounds like a good way to penalize poor folks and have them avoid using the system altogether, resulting in worse outcomes and higher cost burden on the system when preventable issues aren't dealt with proactively.

I get where you're coming from and agree that preventing frivolous calls is a good aim, I don't know that a fee is the right solution.

It looks like they're considering what I proposed, it's just taking them a while to implement it.

"The new ordinance also allowed the city to levy fines against facilities deemed to be making frivolous or excessive emergency calls."

You have a point about the possible downsides. It would have to be done well, such as doing what you suggested by limiting the fee to commercial facilities.

For an insurance company, who'll burden the cost, they're the same problem. Different cause, but same problem.

> and the company was uncomfortable shouldering the financial and legal cost of trying to create a solution.

Did they find a solution before determining that?

> Our research lead us to find that a high percentage of elderly folks (50+)...

People in their 50s are now considered elderly?

50%+, assuming.

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