A study made by the Heart Foundation of Australia showed that the cost of ambulance fees is the primary consideration of the public when dialing for medical assistance even during emergencies.

The study which collected multiple data sources, including scientific survey data, medical studies and analyses of data in regions that have imposed ambulance fees, indicate that ambulance fees will discourage calls to emergency services for help, risking the health and safety of those experiencing medical emergencies.

Surprisingly, Australia has emergency system similar to that in the U.S.

Heart Foundation said that at least 7% of those surveyed said they would be "very" or "somewhat" likely to delay calling an ambulance due to the costs involved.

A separate survey made in Montgomery County in February 2009 showed that MD found that 74% of respondents believe that it is "very" or "somewhat" convincing that ambulance fees would cause poor and elderly patients needing transport to a hospital to hesitate or delay calling 911.

Three studies in peer-review medical journals found that cost considerations may play a factor in delaying activation of the emergency medical system in cardiac emergencies:

  • Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event," cited in Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome (for the Rapid Early Action for Coronary Treatment (REACT) Study);
  • "The results of this study indicate that indecision, self-treatment, physician contact, and financial concerns may undermine a chest pain patient's intention to use EMS," cited in Demographic, Belief, and Situational Factors Influencing the Decision to Utilize Emergency Medical Services Among Chest Pain Patients, Circulation (Journal of the American Heart Association); and
  • "Lack of health insurance and financial concerns about accessing care among those with health insurance were each associated with delays in seeking emergency care for AMI [heart attack]." Health Care Insurance, Financial Concerns in Accessing Care, and Delays to Hospital Presentation in Acute Myocardial Infarction.

Also, analysis of data from the Fairfax County Fire and Rescue Department shows that EMS calls decreased (when adjusted for population) in the year an ambulance fee was introduced and remain below the pre-fee level. In 2005 (the year ambulance fees were imposed), EMS calls dropped 9% from 2004 levels - this compares to an average decrease of 2.4% over the two years before the ambulance fee. In New Brunswick, Canada, the number of 911 calls dropped approximately 13% after ambulance fees were reinstated. The CEO of the Canadian ambulance service stated that the fees were a likely factor in the drop in calls.