Maintaining the resources necessary to respond with an air ambulance to an emergency is a complex and costly undertaking, much like that of fire departments and hospital emergency departments. The high fixed costs of maintaining a response infrastructure are necessary in order to be ready to serve.
This is especially problematic in maintaining rural emergency care services. Recent studies from the Capitol Area Health Roundtable and the Government Accountability Office (GAO) have highlighted that current reimbursement does not adequately support the cost of maintaining services.
Helicopters and fixed wing aircraft cost millions of dollars to purchase or lease, operate, house and maintain. Highly trained crews available on a 24-hour/7 days per week basis, and the infrastructure which governs, trains, funds, supports, and links them and their service to the EMS system, are also expensive.
As few systems are publicly funded, maintaining the availability of this essential resource inevitably translates into a single patient mission charge that seems expensive in comparison with a lower-priced ground ambulance for the same mission. It has proven a mistake, however, to make such an isolated comparison and to equate the lower charge with cost-effectiveness and the higher charge with costprohibitiveness. In the managed care push of the mid-1990’s, air ambulance service was interpreted by some in this way, as an expensive system contributing to the high cost of health care. They postulated that the industry would shrink and require redesign. That did not happen and, as the value of air ambulance service is increasingly demonstrated, reimbursement for air medical services has actually improved and services have expanded in response to other changes in the healthcare system.
At least one carefully constructed economic model comparing helicopter versus ground EMS has been crafted. It demonstrates that on a system level (that is, funding a system of air ambulances versus a system of ground ambulances covering the same large geographic area and volume of calls), the cost per patient transported would be $4,475 for the ground system and $2,811 for the air system (1991 dollars). A cost-effectiveness study of helicopter EMS for trauma patients by Gearhart and colleagues concluded that such service is, indeed, cost-effective. In looking at the cost per year of life saved by 500 emergency medical interventions, another researcher found the average to be $19,000 (e.g. clot-busting medication treatment for heart attack is $32,678; kidney dialysis is $40,000). That study estimated paramedic ground EMS to cost $8,886 per year of life saved while the Gearhart paper establishes a comparable figure for medical helicopter use of $2,454.
As increasingly difficult decisions about apportioning health care dollars in our aging society are faced, air ambulance service should not only be considered cost-effective in its current roles, but may increasingly serve medically isolated populations in new ways.
