With an ambulance gurney cradling his defeated body, Raohl Hursh sought peace with his past inside the frenzied emergency room of the UC San Diego Medical Center in Hillcrest. It was his 29th visit in four years, his 12th in a month, his second in four hours.

“I’ve already tried to kill myself,” the former serviceman with a history of mental illness said, vodka-addled and occupying a room where a beehive of doctors and nurses would soon hover over a heart-attack patient. “I’ve killed others. ... So I’m being punished for all this. It hurts. It hurts.”

In San Diego, according to the city medical director’s office, 1,136 frequent users are on course to use the EMS system at least six times this year, and to generate more than $20 million in ambulance and paramedic charges alone. They represent a minuscule eight-hundredths of a percent of the city’s population, yet account for more than 17 percent of paramedic and ambulance calls in the city.

Across the country, in Massachusetts, WBUR’s Martha Bebinger is at work on a similar project that focuses on another demographic that tends to use a higher level of health-care services: the elderly. She’s following 65-year-old Sue Beder, who has suffered from multiple sclerosis for more than four decades:

Beder [has] offered cookies as thanks for the roughly 40 trips firefighters made to her home over the past year. Beder’s emergencies — a few of which sent her to the hospital — started with a seemingly simple problem: She couldn’t get to the kitchen to pour herself a glass of water or get food.

“I’d be standing here trying to walk to the bathroom and I would just fall,” she says, describing the days before she signed on with her new agency. “I would call my children, see I have the Lifeline, thank God, and they were getting angry with me.” Beder pauses and purses her lips. “They [my sons] wanted me to go someplace, but I’m happy here. This is my home. So, I always needed the ambulance to get me up.”

Beder and Hursh are the patients that health-care economists worry about the most: The small sliver of the population that accounts for a big chunk of our annual $2.6 trillion spent on medical bills.

They’re also becoming the focus of new efforts across the country to provide better care at lower costs. Beder has just enrolled in a new insurance plan in Massachusetts called Senior Whole Health, which will try to deliver her care for 20 percent less than the $7,000 a month it costs now. If it can hit that metric, or get even lower, it will net the difference as profit. The company has bought in a nurse to assist Beder in day-to-day activities. The hope is that the nurse, much less costly than an ambulance, will be the one that ultimately helps Beder to get up.