Charges for Services – Double the Ambulance Fee

 Revenue: $13.2 million in 2012, $24.7 million in 2013

The Chicago Fire Department (CFD) has been providing ambulance services since at least the 1920s.[1]  From 1957 to 1977, the number of ambulances in service increased from 16 to 43.[2]  Today, there is an average of at least 60 ambulances in service each day.[3]

In 1985, CFD started to charge a fee for ambulance service:  “In order to take advantage of available reimbursements from Medicare, Medicaid and private insurance companies, Chicago created the first ambulance user fee in 1985.”[4]  The chart below sets forth the fees for 2008-2011[5]:


2008 Fee

2009 Fee

2010 Fee

2011 Fee

Basic life support:





Advanced life support:





Advanced life support II





Additional fee for non-residents












    $25.00 (regardless of the amount)

*The paramedics transport patients to the nearest hospital (usually 2-3 miles) or nearest trauma center (may exceed 2-3 miles) if necessary.

As the fee has increased, the City has raised substantially more revenue as shown in the chart below:




Ambulance Fee Revenue




Source: Financial Management and Purchasing System

The stated purpose of ambulance fees is that City residents do not subsidize the cost of ambulance services when those costs are more appropriately borne by those who use the services.  The 2011 budget includes 630 firefighter positions assigned to Emergency Medical Services.  The labor costs for these positions are $69.5 million annually.[6]  This figure does not take into account fuel and the operating and maintenance costs for the ambulances.

Under this option, the City would double the fees it currently charges for each service provided by its ambulances.  The charts above show that, in 2009, when the City last doubled ambulance fees, revenue only increased 35 percent.  This is likely due to the fact that the City does not collect revenue from fees very quickly.[7]  Assuming that revenue would respond similarly in response to doubling the fees as it did in 2009; the City would raise an additional $13.2 million in 2012 and $24.7 million in 2013.[8]

Proponents might argue that City taxpayers should not be subsidizing medical care for residents and non-residents who use the City’s ambulances.  The City provides ambulance services to ensure that people have timely access to life-saving medical care, but it should charge a fee that adequately covers the cost of providing the service.


Opponents might argue that many low-income residents use the City’s ambulances and charging higher fees would have a negative financial impact on these residents.  Additionally, the imposition of higher ambulance charges could cause residents who need care to fore-go calling an ambulance in order to avoid the fees.






Budget Details

Fund: Corporate Fund, 0100 Type of Revenue: Charges for Services: Safety
The appropriation is on page 17 of the 2011 Annual Appropriation Ordinance.



[2] Id., pg. 11

[3] City of Chicago. “Labor Contract between Chicago Fire Fighters Union, Local #2, International Association of Fire Fighters A.F.L.-C.I.O. – C.L.C and the City of Chicago, Illinois. July 1, 2007 through June 30, 2012.” Section 16.4 (B)2(a) pg. 67

[4] City of Chicago. Chicago Fire Department. “Ambulance Bills.”

[5] Id.

[6] This assumes fringe benefits are 43 percent of salary.

[7] Spielman, Fran. “Fee for ambulance ride could jump to $1,200.” Chicago Sun-Times February 27, 2007.

[8] This assumes a 35 percent increase in revenue in 2012 and an additional 22 percent increase in 2013, compared to the 2012 revenue, due to the fee increase.