The fact that the cost of air ambulances has risen sharply in recent years comes as no surprise. According to travel association ABTA, an air ambulance in 2024 cost more than twice the amount charged in 2019.

Rate of inflation

Looking at Europe, in 2019, an air ambulance from the European Union back to the UK cost €15,000–€20,000; by 2023, this had risen to €25,000–€30,000. This vastly outpaces general healthcare inflation, which a recent WTW report estimated at 8.6% in Europe. 

Medical repatriations are among the fastest-growing claims expenses for European travellers. Previous ITIJ articles have attributed increased pricing to the cost of fuel, aircraft maintenance, and stricter compliance requirements, to mention a few contributing factors. Let’s focus on the logistical difficulties faced by operational assistance companies and how we can manage costs effectively while still delivering optimal patient outcomes.The reality is clear: rising costs are driven by inflation but also by operational red tape that makes cost containment increasingly challenging.

The reality is clear: rising costs are driven by inflation but also by operational red tape that makes cost containment increasingly challenging

Money versus medicine

In assistance, our responsibility extends far beyond simply coordinating patient care; we must also consider financial implications for the insurer alongside making decisions based on sound medical judgement (balancing clinical necessity with financial responsibility to insurers). A balance must be struck: the repatriation must be financially contained but also medically sufficient to meet the requirements for the patient condition and aviation guidelines, but not so extensive as to be unwarranted for the circumstances. 

At Collinson Insurance, our experienced aviation-trained medical team assess a patient’s situation to make appropriate repatriation recommendations. The operational team must then source such a repatriation that at least meets these recommendations – however, this highlights a critical challenge we face operationally: the medical recommendation is not always logistically viable. While a ‘lesser’ operational solution would breach medical and aviation requirements, only ‘higher’ solutions can be considered – which, in turn, brings increased cost considerations. While we pride ourselves on putting the patient at the forefront of every decision, financial deliberations inevitably follow very closely thereafter.

While we pride ourselves on putting the patient at the forefront of every decision, financial deliberations inevitably follow very closely thereafter

Let’s consider some scenarios where the best patient outcomes surpass minimum repatriation requirements.

Upgrading a stretcher

While a commercial stretcher repatriation might meet minimum repatriation requirements, the logistical reality often means upgrading to an air taxi. Here are some relatable factors that drive such a decision.

Availability constraints: in many tourist locations, commercial airlines that can facilitate a stretcher are at best limited, or not available. Even short, popular routes, such as Ireland, Spain or France to the UK, and all US airlines, are unable to provide stretcher carriage, making an air taxi the only practical alternative. According to a report provided by Christine Millson at Meon Travel Management, this is because fewer airlines now offer short-distance stretchers due to the additional expense of ground handling and disruption to aircraft scheduling.

Time sensitivity: commercial stretcher arrangements are notoriously time-consuming, taking up to 10 days for clearance approval from some airlines – the longest being in Japan, China, and India, said Meon. In contrast, an air taxi can typically be expedited within 24 hours, which is a significant time saving. This has the additional benefits of mitigating the medical risk for the patient and overseas admission costs for the insurer. 

Cost considerations: when a stretcher is available, protocol is to provide two medical escorts, but, surprisingly, in some parts of Europe, an air ambulance or air taxi can be more economical. When adding costs such as escorts, last-minute ticketing, accommodation and transfers, the price of a commercial stretcher grows quickly, making an air taxi a sensible solution for cost containment, resulting in reduced premium outcomes. Transatlantic and long-haul flights can easily run into tens of thousands of pounds, said Meon, reaching well over £30,000.

Medical necessity: while a particular medical condition may, on the surface, require a stretcher repatriation, this may also be contraindicated if, for example, continuous monitoring or severe pain dictates the need for a direct, uninterrupted journey. In such circumstances, a commercial stretcher where no direct route exists means multiple layovers – which is no longer clinically appropriate. 

Route limitations: when a stretcher repatriation is available country to country, it is inevitably restricted to  large or city airports. This often means patients face long ground transfers from tourist destinations to a suitable airport. This extends journeys far beyond the duration of the flight by several hours – which in turn puts the patient at increased medical risk and adds to the overall cost.

For what ought to be a commercial stretcher repatriation, an air taxi is often a safer, more efficient, or cost-effective solution

The report from Meon went on to explain that over the past decade, fewer airlines have provided stretcher services, not due to lack of need, but because of cost, complexity, and risk: modern aircraft cabins are less flexible, with a stretcher installation blocking six to nine revenue seats, making it expensive. Strict regulatory and engineering requirements, combined with medical and legal risks, add further challenges. Stretcher transport remains vital, but, for most airlines, the operational burden now outweighs the benefit.

When an air ambulance is the solution

As we can see, limited stretcher availability and the need for rapid deployment often force assistance companies to consider high-level alternatives. For what ought to be a commercial stretcher repatriation, an air taxi is often a safer, more efficient, or cost-effective solution. What this demonstrates is the ability to look beyond the obvious and keep patient care at the heart of every operational choice. Benefits to the insurer are an added and welcome bonus.

Managing rising air ambulance costs

While air ambulances are broadly considered as expensive, they can in effect be the financially sensible option when circumstances demand rapid, medically appropriate transport. Increasing insurance premiums is an unattractive response that could reduce insurance uptake and does not address the root cause of escalating costs.

From an assistance perspective, the focus should remain on operational efficiency and proactive case management with the patient always at the centre of decision-making. Nevertheless, the challenge for insurers and assistance companies is managing these costs without compromising patient safety or clinical standards.

What the numbers tell us

Internal research at Collinson Insurance highlights a clear upward shift in the cost of air ambulances over the past three years. In 2023, the average cost per mission was £18,980 and in 2024, this figure rose to £21,619 – a significant increase in one year of nearly 14%. For 2025 up to Q2, the average was £21,799, with the peak season figures yet to unfold. These numbers suggest that rising costs are not a temporary spike but indicative of a trend. Naturally, these averages provide a benchmark, and averages are influenced by factors such as the type of aircraft required, distance, routing, and medical limitations.

Cost containment without compromising care

Early intervention: when an air ambulance is the only option, there are still proactive and impactful operational measures available to mitigate cost escalation. Acting before a patient deteriorates can prevent escalation to a full-scale emergency, where clinical urgency removes the option of repatriation altogether. This means working closely with medical experts to identify high-risk cases so that the assistance team can explore repatriation options sooner rather than later. If the patient is going to require an air ambulance for the foreseeable with little likelihood of a lesser repatriation, why not expedite it sooner?

Delays don’t just inflate flight costs and upset customers – they increase insurer exposure to additional overseas costs. Every extra day spent in a foreign hospital adds bed charges, medical treatment, ancillary charges, and family accommodation costs. In some cases, establishing a faster solution – even if the transport price is higher – can reduce the overall claim cost. For example, an air taxi arranged promptly may cost more than a stretcher flight, but if it avoids a week of inpatient care abroad, the net saving is substantial.

While air ambulances are broadly considered as expensive, they can in effect be the financially sensible option when circumstances demand rapid, medically appropriate transport

Timing is everything: requesting a last-minute mission limits cost containment opportunities because there is little leverage available with operators. When a repatriation is notified late, availability is limited, and providers know that urgency drives decision-making, leaving assistance companies with little bargaining power. If we can spot a potential air ambulance early, there is more opportunity to source competitively and optimise routes, which can take thousands off the final bill.

Ultimately, managing costs in air ambulance claims requires early escalation, proactive case management, and operational agility. By leveraging clinical expertise with logistical efficiency, assistance providers can deliver solutions that avoid unnecessary additional costs without adversely affecting patient care – or, in some cases, improve the customer journey.

Conclusion

There is no need to cut corners to manage rising costs. As prices inevitably continue to climb, we must combine operational efficiency with clinical integrity and patient outcomes to avoid additional and unnecessary costs. This requires experience and foresight with continual monitoring of developing trends – especially where stretcher availability continues to fall.