Public vs. Private Emergency Medical Services and COVID-19 Mortality Outcomes in Texas: A Spatial Panel Analysis

Although Emergency Medical Services (EMS) are integral components of pre-hospital care, their operational role in relation to COVID-19 mortality rates remains underexplored. In the U.S., EMS agencies vary widely in ownership, with both government and private for-profit providers operating under relatively low regulatory barriers. These differences may influence population health outcomes, particularly during public health crises. This study examines the effect of public and private for-profit EMS providers on COVID-19 mortality in Texas. Utilizing data from the Texas EMS roster and COVID-19 records supplied by the Texas Department of State Health Services from March 2020 to February 2023, we calculate the proportion of EMS vehicles operated by government and for-profit providers and assess their association with COVID-19 mortality rates. Spatial Durbin Error Panel regression models reveal that having over 50% of government EMS vehicles in the county was associated with lower COVID-19 mortality rates in three of the six panels. In contrast, for-profit EMS showed limited and inconsistent associations with reduced mortality; statistically significant effects were only observed when their proportion was lower. These findings suggest that a greater presence of government EMS vehicles, compared to for-profit vehicles, may contribute to improved public health outcomes in terms of COVID-19 mortality.