In spring 1990, the Southern California Health Policy Research Consortium undertook an analysis of the problems being experienced by the emergency medical service (EMS) system in Los Angeles. As a member of the consortium, RAND conducted this initial review of the emergency medical care system. Three sources of information were evaluated concurrently. People familiar with the emergency medical services system in the county were interviewed, and published agency documents were reviewed. A preliminary quantitative analysis also was performed, using data on emergency services reported routinely by hospitals to the California Office of Statewide Health Planning and Development. Diverse issues were identified. Many of these issues relate to two general concerns: (1) the stress placed on the EMS system by uncompensated care, and (2) the effect of the basic system structure on its operating effectiveness. The authors discuss key issues within each concern.
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