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The high charges of HEMS in the USA

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The high charges of HEMS in the USA

Old 26th Nov 2018, 22:18
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The high charges of HEMS in the USA

CNN report on “Sky-high prices for air ambulances hurt those they are helping”
https://www.cnn.com/2018/11/26/healt...ice/index.html

North Dakota average patient charge per flight is US$56k.
“Balance billing” and “for profit” nature of the industry is said to be the cause of high charges to patients, even those who are insured.

20 years ago I recall filming an emergency helicopter in California where the patient, who had come off his motorcycle in the hills was adamant that he didn’t want to be transported by helicopter as he was unsure if his insurance would cover the flight. He was suffering back pain but was prepared to wait for his brother to artive to transport him in the back of his pickup truck!

So are there still cases today where a HEMs lands but patient refuses for similar reasons?

Here in Oz a $94 family/$47 individual per annum subscription covers ground and air ambulance. Each state has a not for profit “service”.

What is it with the USA and both the high cost of health care and the lack of adequate insurance?

Table of fees in Victoria. https://www2.health.vic.gov.au/hospi...ambulance-fees

mjb
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Old 26th Nov 2018, 22:28
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Originally Posted by mickjoebill View Post
CNN report on “Sky-high prices for air ambulances hurt those they are helping”


North Dakota average patient charge per flight is US$56k.
“Balance billing” and “for profit” nature of the industry is said to be the cause of high charges to patients, even those who are insured.

20 years ago I recall filming an emergency helicopter in California where the patient, who had come off his motorcycle in the hills was adamant that he didn’t want to be transported by helicopter as he was unsure if his insurance would cover the flight. He was suffering back pain but was prepared to wait for his brother to artive to transport him in the back of his pickup truck!

So are there still cases today where a HEMs lands but patient refuses for similar reasons?

Here in Oz a $94 family/$47 individual per annum subscription covers ground and air ambulance. Each state has a not for profit “service”.

What is it with the USA and both the high cost of health care and the lack of adequate insurance?

Table of fees in Victoria. https://www2.health.vic.gov.au/hospi...ambulance-fees

mjb
Mick

In Alberta Canada the ground ambulances are run by the provincial gov't and bill to the individual patients at about $300.00 per trip I believe ( Not sure as I haven't had to use them knocking on wood) The air ambulance Stars is ran as a non profit that gets money from the Gov't, Corporations and private individuals plus some in house fund raises that they do.

I count ourselves luck that we have these services at what sounds like bargain prices compared to what your showing.

Roybert
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Old 26th Nov 2018, 22:39
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It is a bad situation for sure.....but when you crash helicopters as frequently as some Operators do....you have to find a way to pay for them.

Add in the numbers of un-neccessary helicopter transports and the industry really does look bad.

When Hospitals were willing to underwrite some of the helicopter costs in trade for the expensive healthcare procedures that tended to follow intake....the cost to the patient for the transport was pretty reasonable even if not cheap.

Now with non-hospital based services cropping up with cheap singles and the need to keep the revenue flowing....bad things happen and costs go up.

My State did not operate any EMS aircraft but did tightly control the numbers and types of operations that would be accredited and licensed within the State.

We remain a free capitalist economy pretty much....and prefer government to stick to that business they are allowed by law to get into....and wish they were involved less in less than they are pretty much.

Discussions of changes jn the American way of Healthcare and Health Insurance....two distinctly different things....should we see a shift in control of Congress and the White House does not bode well at all for any of us.

The move is on again by one party to go to a Single Payer System, move 200 Million People into the our Medicare system (now thought to be bankrupt in as few as eight years as it is now without any changes) and about 31 Trillion (with a T) additional cost over Ten Years alone.....and you can see we are headed for a genuine crisis that makes the current situation look almost "Good".

We have far too many States, too large a Federal Government tangled web of Bureaucracies, too powerful a group of special interests and too many legislators on the local, state, and federal level with open palms to see a good and judicious outcome I am afraid.
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Old 26th Nov 2018, 22:50
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Somebody has to pay. These things are not free wherever you live. In more socialist countries it is paid for via governmental subsidies obtained by MUCH higher tax rates. Consider that someone making $150K AUS is in something like a 37% tax bracket, while in the US the dollar equivalent puts you in a 28% tax bracket, give or take depending on what year's data you look at, exchange rates, all that sort of thing.

In the US my insurance costs have doubled since the onset of Obamacare. That's because instead of being taxed directly via federal income tax, as a gainfully employed member of society I now have to pay my insurer double so that they can turn around and insure those who are not contributing members of society. It's effectively an indirect federal tax.

Obviously the system is horribly broken. In the US, where health care and insurance are concerned, we now live in this terrible purgatory between outright socialized medicine and the old semi-capitalistic system where those who could not afford it didn't get anything. Like a lot of Ugly Americans, I'm a staunch capitalist and would be happy to go back to the old ways, paying less for taxes and health care. Alas, one cannot buy votes that way, and buying votes is the name of the game with an unrestricted electorate. It's only a matter of time until we are "socialized" to the same degree you mates and chaps are.

Meanwhile, in terms of refusing transport, I was, for some eight years, an EMT on a ground ambulance service. In an urban area I can tell you unequivocally that most air transports are a racket. Not all, but most. By the time you make the decision for air transport, set up the LZ, wait for the bird, wait for it to shut down, do all of their stabilization and packaging procedures, start up and depart, you could have been sitting in a local ED (A&E, whatever you call it in Australia) or even in an OR. Tell you what: you can pick me up at the local hospital pad if you want to transport me that badly, at least I'm within feet of definitive (surgical) care while I'm waiting, not sitting on an LZ waiting. Now that obviously flips on its head in the more rural areas. But because of population densities most air transports in the Northeast happen even though you are within 10 minutes of a perfectly good operating room and often within 10 or 15 minutes of a perfectly good Level II trauma center. So, yeah, it's a racket. Of course, most folks who are so transported are not conscious and alert enough to demand to be taken to the nearest OR equipped ED/trauma center while they wait, so that's a problem!
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Old 27th Nov 2018, 03:38
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Originally Posted by mickjoebill View Post

What is it with the USA and both the high cost of health care and the lack of adequate insurance?

mjb
As a Yank I can say with all certainty,...

My country is run by money grubbing assholes! That's what it is.
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Old 27th Nov 2018, 03:48
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If you are wise you purchase a membership from the HEMS company, if it's available. For the high price of $49 a year my entire household is covered by both helicopters (two Bell 429's and I believe 3 407 GX's) & a King Air. They will send a helicopter up to 150 miles, the plane up to 500 miles to get us. There may be minimal charges after that, but certainly not thousands and thousands of dollars.
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Old 27th Nov 2018, 04:14
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Part of the cost is due to the fact that the companies receive no money if they don’t take a patient, so all costs are borne by the ones that get transported. Generally 3 crew (pilot, paramedic, flight nurse) on rotation for 24/7 coverage, all the specialized medical gear, and the cost of the helicopter itself. All those costs covered by those who are transported.
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Old 27th Nov 2018, 10:43
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I live in the middle of England and our air ambulances are operated by charities with no contribution from the Government. Our local air ambulance charity operates three Airbus EC135's, G-OMAA, G-HWAA & G-EMMA. Their website is Midlands Air Ambulance Charity | Saving Lives by Saving Time and will make interesting reading to our American friends.

With all of the excessive costs of EU regulation, twin engine machines etc, etc they say the average cost of a mission is £2,500.

Quote from the website:

"Each year it costs in excess of £9 million to maintain the three aircraft and the provision of a lifesaving service. Each air ambulance mission costs an average of £2,500. The charity receives no funding from the Government or National Lottery so relies entirely on the support and generosity of local people and businesses."

The US system would appear to be spectacularly expensive and unreasonable.

(Just for clarity, I have a capitalist mindset - it would appear to me there is room for great margins between £2,500 - £40,000 per flight respectively).
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Old 27th Nov 2018, 11:07
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Originally Posted by CRAN View Post
Our local air ambulance charity operates three Airbus EC135's, G-OMAA, G-HWAA & G-EMMA.
Slightly out of date Cran, it's 2 x 135s and 1 x 145T2 (GRMAA) now.

Cheers TeeS
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Old 27th Nov 2018, 11:14
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Air Methods is a very large player in the US EMS industry.

The Link will take you to an Annual Report that discusses factors that impact their Operation and generally describes one Years business results.

Cran....compare your Charity Operation to Air Methods and see if you are making an Apples to Apples comparison of services and capability.

https://www.airmethods.com/docs/defa...rsn=76819d95_2
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Old 27th Nov 2018, 11:54
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I studied and compared different HEMS systems, mostly Europe but USA too - it was part mof my thesis some years ago.
I can only say, that US HEMS is, with some bright but rare exceptions, a complete f....k up. Even many hospital based services.
First: fixed costs for such operation are enormous compared to variable cost (cost per mission) Often, it is way over 80% of total cost of operation.
But, under current payment schemes, revenue is generated only per patient transported - this forces providers to take as much patients as possible and this creates two wrongdoings:
- strange arrangements on picking patients (suspicuous criteria for use of helicopters, forcing patients into helicopters, pushing for heli transport of patients, that most of the time, do not need it etc)
-pushing into bad weather to try and transport the (paying) patient as turn back or empty flight does not create revenue -same goes for sitting on the ground and waiting for the weather to improve. Adding to that, some less responsible companies are trying to lower high burden of fixed cost by use of cheapest possible helicopter. Flying a Long Ranger in marginal weather or at night without basic stabilisation, let alone a decent autopilot and even no NVG is a Russian rulette.

Since health care in U.S. is, compared to services in EU, more or less a commodity, sold same way as other services on the market, free market law apply - but with some exemptions, that forces providers to provide service, without knowing if customer is able to pay for it. This leaves them with many bills unpaid as emergency service most often cannot be declined or better to say, service providers are gambling on balance between able and unable to pay customers.
Effectivelly that means that those, able to pay are covering for those that avoid payment one way or another. and that operators are trying to squezze out as much as possible from unaware customers. Those that protest and become loud are potentially damaging to those businesses and often get away with a settlemet - a massive write-off which is, in reality, a fair price.
Just a hint: in Austria, a 15 min flight from ski resort to hospital with decently equipped and staffed EC-135, operated by a pure commercial company will not cost more than 5000 Eur - and they run for profit.
But, since such transports are free market area in Austria, companies mushroomed and sadly, I see some U.S. HEMS trends coming.

My personal opinion: as long as Americans do not want to accept that there are some common issues that need common solutions in a society (or better to say, accept that there is a thing, called "society"), they have to accept the current situation.
Now, fire back.
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Old 27th Nov 2018, 12:36
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Has anyone tried the UK charity model in the US and elsewhere [and presumably failed]?

It seems odd that it works so well here with minimal government money and yet apparently 'copious' amounts of charitable giving. I realise it is partly to do with population density [it is pretty crowded here] but you might expect the 'free at the point of service' to work fairly well in and around cities across the world. It would appear that even the paid for US model has pretty strict boundaries...... so paying your membership dues to an air ambulance in Washington State would have no value if you had a need in DC?

No matter who you are or where you are in the UK if you need an air ambulance doctor brought to you or if you need removing from scene by air you will never get a bill. It is peace of mind all round.
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Old 27th Nov 2018, 12:59
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The idea that people without Health Insurance cannot get health care in the USA is a myth.

One of the problems is the un-insured or those who do not qualify for government funded healthcare too often show up at Emergency Rooms/Trauma Centers to obtain what at best would be Urgent Care treatment or Primary Care Treatment.....and of course are unable/unwilling to pay for that treatment which cannot be denied by the facility.

The provider may limit their provision of care to that which is necessary to stabilize the patient then transfer the patient to another facility.

Those with Insurance, the Tax Payer, and those who self fund their healthcare do in fact wind up paying for the indigent who cannot afford or do not otherwise have healthcare insurance or coverage under a government funded source.
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Old 27th Nov 2018, 13:32
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In Maryland, the only charge for State Police helicopter extraction/transport is a token fee ($6, I think) that everyone pays each time they register or re-register a vehicle.
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Old 27th Nov 2018, 13:40
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At that level the same happens here.

Even well off people arrive in the UK for treatment of expensive ailments or even child birth, take the free treatment and venture back home wherever that is and dodge the bills. They amount to ten of millions but in a budget of billions it is chicken feed.

in a country where treatment is free there are few if any measures in place to seek or take payment from anyone. The percentage of those who need to pay is so low that it’s not even economic to set up a “pay here” facility at all hospitals (as much as we would like to take the money off them)
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Old 27th Nov 2018, 14:55
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Try that in a country of over 300 Million people with somewheres around 12-15 Million Illegal Immigrants and all of the indigenous poor....it ain't Chicken Feed we are talking about.

Also....recall most of our medical facilities are "For Profit" operations that are privately owned and not government funded and operated.
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Old 27th Nov 2018, 23:50
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Originally Posted by mickjoebill View Post
What is it with the USA and both the high cost of health care and the lack of adequate insurance?
The one item always missing from these discussions is that US law prevents the possibility of trying to change these issues.

For example, helicopter EMS ops is "protected" by the Airline Deregulation Act of 1978. Believe it or not. Every time a State tries to reel in the EMS costs the operators play their dereg card and win. Until congress legislates these ops out of the Act they will continue.

The lack of insurance... is a misnomer. Everyone in the US has access to healthcare whether they can pay or not. Walk into any hospital emergency room and you will get treated. It's against the law not to treat you. However, in the big picture, if congress would legislate the ability to purchase medical insurance outside the state in which you live... the free market would bring costs down and offer better alternatives, Currently, by law, I can only buy insurance from a company with offices in my state.

And while obamacare was all the talk, it has slowly taken the existing insurance system and buried it. Out of 175M working adults, 120M get insurance from their work. The other 50M were supposed to be taken care by the ACA. What they failed to detail was that 30M of that 50M were going to get free healthcare through an "expansion" of the Medicaid system (low-income). The paying obamacare group never got above 24M. So guess who has to pay for those 30M?

The funny thing is, the hype on the ACA was it was to help "middle-income" folks. But with the current median single income of around $52K per year, how come all ACA subsidies stop at $49K income per year? The insurance company lobbyists are a close second to the defense industry lobbyists. Until that bond can be broken, our healthcare system will remain broken.
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Old 28th Nov 2018, 00:01
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Norway- All this is FREE

Hi
Here in Norway MEDEVAC is free , hospital free, doctor free( after annual max 300euro)
All education from 6 years to Professor is FREE!
How you say?
We do not piss away the money to the greedy capitalists!

Oh and PS:
Our personal tax are the lowest in Europe.
You all have a healthy day now.
Regards
Cpt B
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Old 28th Nov 2018, 05:32
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BluSdUp : while I am all for free healthcare and education don't misrepresent your country to the americans, please. that's intellectually dishonest. you know very well that the cost of living in norway is incredibly high, which prices that are significantly above for many items than in denmark, sweden, germany. it all balances out. the americans here are proclaiming their taxes are lower but in the end they pay just as much, only through different systems and processes. I've lived and worked on both sides of the pond.
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Old 28th Nov 2018, 07:13
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Has anyone tried the UK charity model in the US and elsewhere
In Switzerland we have the REGA. I pay CHF 70 for the whole family and that covers helicopter rescue in Switzerland and repatriation by either airline or their own jets worldwide. Health insurance does cover part of the rescue, too. REGA is now an essential part of the Swiss rescue system, it would not work without it.
REGA is a non profit organization and is very (very, very) well funded, since almost everybody is a patron. There are three other companies doing rescues for profit: Air Glaciers (always whining why they have to use twins and then rolling them), Air Zermatt (very professional) and Lions Air/Alpine Air Ambulance under the cover of TCS (Touring Club Switzerland). The first two are located in the Wallis, whose populations just has to do things different as the rest of Switzerland as a principle and the third seems to have responded to local politicians, who where apparently annoyed with REGA, because there was no helicopter base in their county or something like that (it smells extremely fishy). For a rescue by Air Glaciers or Air Zermatt, patrons of REGA are covered, but not for the Lions Air/Alpine Air Ambulance/TCS.

REGA is in very high regard and known to every child, which is essential to their success. It would be very difficult to build something like that from scratch, since REGA grew up with the helicopter business in general in Switzerland. A time when pioneers were in high regard and new things welcome (well, more than today a least).
I find it funny, when the discussion comes to free market and health care. In case of an emergency, there is no such thing. The customer has no choice, than to take the emergency transportation that is coming to his/her rescue. The US proves every day, that a free market in health care produces the most expensive health system in the world with a declining live expectancy. That is not a success story.
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