Can air medical industry regulation maintain financial stability and safety?

Montana lawmakers are considering regulating air ambulance service costs because of the high balance patients are left with, even after insurance payments


Air medical services have been part of the prehospital care landscape since its inception. From private industry to publicly-funded systems, helicopters and fixed-wing aircrafts have provided time-sensitive care and transportation to patients who experienced medical emergencies far from an appropriate receiving facility.

There’s likely little doubt in most people’s minds about the necessity of this vital service.

But at what cost?

As this article examining the costs of helicopter transport in Montana points out, air transport can cost tens of thousands of dollars. Insurance companies pay very little of the bill, leaving the bulk of the amount due to the patient or family members to try to pay. In contrast, the average cost of an emergency department visit is about $2,000; another study found it costs about $30,000 to manage an acute myocardial infarction [1, 2]. The air transport bill quoted in the article was about $50,000.

There is no question about how expensive it is to maintain 24/7 readiness of an emergency service. Any EMS system manager can tell you what it costs for labor, operations and overhead. Ground EMS systems can deploy their systems dynamically, bringing in more units during peak load periods and scaling back when volume is low. That’s not as easy when only one or two air units are available in a given area.

An air unit could increase the number of calls it sees in a shift. In areas with several air medical units, decreasing that number might result in more calls. However, it would not be without cost — helicopters are expensive to operate and maintain.

What is the human cost of more aeromedical responses? Unlike ground units, crashing an air unit is usually catastrophic to onboard members.

In the end, there isn’t a clear answer on how to address the high cost of air medical services. With all of the factors affecting a decision to regulate, legislators will need to work carefully to maintain safe operations while also maintaining financial stability.

  1. Brill S., Bitter Pill: Why medical bills are killing us. Time April 2013. Retrieved 30 November 2015.
  2. Wang G. et al., Costs of Hospitalizations with a Primary Diagnosis of Acute Myocardial Infarction Among Patients Aged 18-64 Years in the United States. Retrieved 30 November 2015.

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