Outsourcing in US cities, ambulances and elderly voters

This paper develops a public choice model of city service provision, and uses empirical analysis to pin down some of the model’s key assumptions. Many of the largest cities in the United States outsource emergency medical services, and analysis of data from the 200 largest US cities finds that a number of variables are significant determinants of emergency ambulance outsourcing, including the fraction of a city’s voters over the age of 65. This finding provides evidence that elderly voters are important in policy determination, and suggests a particular shape for the model’s contracting cost curve.