View article

The literature on multiple-goal organizations highlights the unique challenge of simultaneously meeting potentially conflicting financial and prosocial objectives. In this paper, we study how frontline employees deal with these competing demands within the context of Emergency Medical Service (EMS) crews responding to 9-1-1 calls. Using data from 31 states reported to the US National Emergency Medical Services Information System, we find that even in the absence of direct and immediate individual financial incentives, EMS crews are responsive to the financial objective of their agencies by providing higher levels of service to patients with higher ability to pay. We find that both private insurance and Medicare patients receive more procedures (4.6% and 1.5%) and have longer transport times (5.1% and 3.9%) than Medicaid patients controlling for time, call, patient, and condition characteristics. However, we also find evidence suggesting that EMS crews dynamically vacillate between organizational objectives between calls, depending on the context and the salience of the objective. We find these ability to pay differences increase on busy days when the financial opportunity costs are high, and when their employing agency has stronger financial need. However, disparities decrease significantly when calls are life-threatening, as patient needs overcome financial considerations. Surprisingly, these patterns hold across organizational forms including public, private, and non-profit organizations.