Helicopter transport is more expensive than ground transport, with an average helicopter transport charge in 1997 of $3882 for a medium-sized twin-engine helicopter and a 50-mi one-way patient transport.1 The fees charged by almost all programs include a base fee for liftoff plus a fee for loaded (one-way) mileage. 1 Some programs charge for professional services and drugs or medical supplies used in flight.
Reimbursement issues are complex and vary between government (Medicare and Medicaid), private insurance, and managed care health insurance plans. One program found that, with an average flight charge of $2298 in 1991 through 1992, mean reimbursement was $991, or 43 percent of charges. 28 Reimbursement rates varied from nearly zero for Medicaid to 90 percent for commercial insurance.
The cost-versus-benefit analysis of air medical transport is not easy. It is not easy to predict how a patient might deteriorate if sent by ground rather than by air. It is not enough to ask the simple question: "Would the patient have died if not transported by helicopter?" Other medical factors, such as the number of days in intensive care, duration of rehabilitation, and quality of future life may be positively affected by air medical transport. Models have been developed to analyze the cost-effectiveness of using a helicopter to provide advanced life support (ALS) to local BLS ambulance services instead of placing additional ground ALS vehicles. A recent analysis found that a single helicopter could provide ALS backup over a 50 km radius replacing six ground ALS units at less annual operating cost. 29
In summary, the determinants of helicopter usage must be medical and driven by national standards, as described above. Currently, there is inherent conflict between the requirements of EMTALA/COBRA for adequate transport and the frequent unwillingness of other federal programs (Medicare) and third parties to pay for the service rendered.
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