Exploring the cost pressures on air medical evacuations in today’s market

The essential role of air ambulance services

Air ambulance services are dedicated aircraft – ranging from helicopters to jets –specifically outfitted for medical transport. These aircraft are equipped with advanced medical technology and staffed by specialised medical professionals, including physicians, nurses and paramedics, to ensure comprehensive in-flight care. These services are vital for transporting patients from remote or under-equipped areas to facilities capable of providing the required medical care; assisting patients with severe injuries or conditions that prevent them from travelling on commercial flights; and enabling patients to receive treatment at home or in more cost-effective locations, especially when local medical costs are prohibitively high.

Key cost-drivers in medical evacuations

In the context of air ambulance services, understanding the escalating cost structure is critical for travel insurance professionals, as it directly influences pricing strategies and policy coverage. Several key factors are contributing to the rising costs of air medical evacuations:

Medical staffing
The need for specialised medical personnel on flights, such as cardiologists or oncologists, can significantly drive up costs. The complexity of the patient’s condition often dictates the expertise required, leading to higher expenses as more specialised care becomes necessary. The increasing demand for highly qualified medical staff on air ambulances also contributes to rising wages and staffing costs.

Destination-related fees
Fees associated with landing, handling and medical care vary widely by destination and are subject to each country’s regulatory and economic environment. Rising fees in many regions are altering the total cost of evacuations, as hospitals and service providers adjust their pricing in response to local economic conditions and inflation.

Fuel remains the largest cost component variable for air ambulance services, and its price is highly volatile

Global supply chain challenges
The air ambulance industry faces substantial cost increases due to global supply chain disruptions. Shortages of crucial aircraft parts, logistics disruptions and the closure of key suppliers have all led to higher operational costs. As supply chain issues persist, the costs for maintaining and equipping air ambulances continue to rise.

Fuel prices
Fuel remains the largest cost component variable for air ambulance services, and its price is highly volatile. Recent geopolitical events, instability in the oil industry and fluctuations in global fuel markets necessitate frequent and often substantial price adjustments by air ambulance providers. Rising fuel prices directly increase the cost of each flight, making it a significant factor in the overall expense of medical evacuations.

Flight path adjustments
Geopolitical and geographical restrictions often force changes in flight paths, resulting in longer routes that require more fuel and extended flight times. These adjustments also necessitate additional staffing hours, complicating pricing and operational planning. The increased complexity of navigating no-fly zones or restricted airspace further contributes to rising costs.

Covid-19 impact
The pandemic introduced additional complexities, such as a shortage of pilots and increased ground service fees at airports. The reduced number of flights during the pandemic led to heightened demand post-Covid, exacerbating the pilot shortage and inflating costs.

Evolution and technological advancements

The air ambulance sector has seen significant advancements in recent years, driven by technological innovation and the desire for more cost-effective solutions. Key developments include:

Advanced medical equipment
Aircraft are increasingly equipped with sophisticated diagnostic and life-support systems, such as extracorporeal membrane oxygenation (ECMO). This technology, which oxygenates blood outside the body, became essential during the Covid-19 pandemic for treating severe respiratory conditions.

Multiple patient transports
Transporting multiple patients on a single flight has become more prevalent, optimising resource use and reducing costs. This approach allows air ambulance companies to maximise aircraft capacity and distribute costs more efficiently.

Promoting empty legs
Utilising repositioning flights (flights conducted without passengers, usually for logistical reasons) as discounted travel options helps mitigate costs. These ‘empty legs’ provide opportunities for cost savings and increased efficiency.

Aircraft upgrades
The trend towards larger aircraft, such as Challengers, allows greater distances to be covered and more extensive equipment and patient accommodations. This shift enhances the operational capabilities of air ambulance providers.

Enhanced communication technology 
Advances in aviation communication, including in-flight WiFi, have improved coordination between medical teams, ground support and receiving facilities, enhancing the overall efficiency and effectiveness of medical evacuations.

Rigorous vetting and ongoing evaluation
As the air ambulance industry expands, maintaining high safety standards is critical. Thorough vetting processes, including insurance verification, aeromedical certification checks and equipment readiness evaluations, are essential. This often involves audits of health, safety and resources, and, where feasible, in-person site visits. Ongoing communication, regular updates to safety and medical protocols, and strict adherence to aviation standards are vital to sustaining reliable, high-quality service amid industry growth.

The complexity of the patient’s condition often dictates the expertise required, leading to higher expenses as more specialised care becomes necessary

Strategic approaches to cost reduction

To address the escalating costs associated with air medical evacuations, USTIA member companies employ several strategies:

Fuel management
Air ambulance providers rigorously monitor fuel prices and choose cost-effective options to minimise expenses. Even minor fluctuations in fuel costs can have a significant impact, given the large volumes required for flights.

Pre-arrival coordination
By communicating with receiving hospitals prior to patient arrival, air ambulance companies ensure that only necessary treatments and medications are provided. This pre-emptive coordination helps avoid unnecessary expenses and streamlines patient care.

Optimising equipment and patient loads
Utilising larger aircraft for multiple patient transports and promoting the use of empty legs are effective cost-containment measures. These practices allow for the efficient use of resources and reduce the cost of these services in delivering optimum patient care.  

Transporting multiple patients on a single flight has become more prevalent, optimising resource use and reducing costs

Future outlook and industry challenges

The air ambulance and medical evacuation industry is poised for continued growth and evolution, driven by technological advancements, increasing global travel and the need for efficient, high-quality patient care. USTIA foresees several emerging trends and challenges:

Integration of advanced medical technologies
The continued incorporation of sophisticated medical equipment on aircraft will enhance patient care capabilities, allowing for more complex medical interventions during flights.

Balancing cost efficiency with quality
As global travel expands, the demand for air ambulance services in remote and underserved regions will increase, necessitating greater operational flexibility and capacity.

Expansion of services
The industry must navigate the challenge of maintaining high-quality patient care while managing costs effectively. Innovations in fuel management, patient coordination and equipment utilisation will be essential in achieving this balance.

Regulatory and safety standards
As the industry grows, maintaining rigorous safety and regulatory standards will be crucial. USTIA and its members are committed to upholding these standards to ensure the safety and reliability of air medical services.

In the ever-evolving realm of air ambulance and medical evacuations, the landscape is marked by significant challenges and opportunities. Rising costs due to specialised medical staffing, fluctuating fuel prices, global supply chain disruptions and geopolitical considerations necessitate ongoing adaptation and innovation within the industry.

As global travel continues to increase and healthcare demands grow more complex, the need for robust, responsive air medical services will only intensify

Technological advancements and collaborative efforts among air ambulance providers are crucial in addressing these challenges and enhancing the efficiency, safety and cost effectiveness of medical transport.

As global travel continues to increase and healthcare demands grow more complex, the need for robust, responsive air medical services will only intensify. Stakeholders in the travel insurance and medical evacuation sectors must remain vigilant and proactive in navigating these changes, ensuring that travellers can depend on comprehensive, reliable support in times of need. 

By staying attuned to industry trends and leveraging emerging technologies, the air ambulance industry is well positioned to meet the evolving demands of modern medical transport, offering critical solutions that protect the health and safety of travellers worldwide.