ITIC Global 2026 | Provider Network Forum

The ITIJ team have been reporting from ITIC Global in Istanbul this week (1–5 November 2026), sharing the discussions that take place at the conference. Read all reports.

Is cost-cutting in travel assistance putting patient safety at risk?

The 10 debate participants were: Bernadette Breton, Chief Executive Officer, AIMS; Dr Cai Glushak, Chief Medical Officer, North America, AXA Partners, and President, EURAMI; Julie Remmington, Director, Real Travel Assistance; Aurélien Gueye, CEO, Medigo; Andrew Minnis, Chief Executive Officer, SATS UK Group; Cem Ustundag, Head of Department for International Insurance Relations, Acıbadem Healthcare Group; Sharon Solomon, Head of Medical Operations, Allianz Partners; Daniela Wilson, Chief Commercial Officer, Airlec; John Segura, Vice President and Head Business Developer, SunMed International; and Louise Heywood, General Manager, International Assistance Group.

From the audience, Thierry Montrieux, Director of Summit Consulting & Assistance, opened the debate by questioning whether the assistance industry was engaged in a race to the bottom. With insurers increasingly demanding lower premiums and operating costs, he asked whether assistance should be viewed simply as a cost or as an investment in the insurance product.

His central argument was that “the cheapest assistance provider is not necessarily the most cost-effective option”. The true cost of assistance should be measured by the outcome of the claim, rather than the price of the service. While technology and automation can improve efficiency, the industry must distinguish between savings that enhance operations and those that compromise care.

The case for responsible cost management

Solomon argued that artificial intelligence (AI) could support responsible cost management without compromising patient safety. Drawing on examples of digital-first care and multilingual GP teleconsultations in Australia, she demonstrated how technology could redirect patients towards appropriate, more affordable healthcare.

Solomon emphasised that AI should support rather than replace human judgement. “AI makes the network smarter; local teams make it work.” Global technology must be combined with local medical knowledge to deliver appropriate care.

Wilson similarly challenged the assumption that reducing costs necessarily compromises safety. She questioned whether the most expensive hospital automatically provides the best treatment, arguing that additional hospital days may sometimes be unnecessary and could expose patients to hospital-acquired infections.

Wilson maintained that the objective should be to provide the right care, at the right time and in the right place. Spending more does not automatically improve outcomes, just as spending less does not necessarily mean compromising care. As she put it, “Patient safety is not determined by the size of the invoice.”

Segura reinforced this argument, suggesting that poor decisions, rather than cost containment itself, put patients at risk.

He argued that providers should be selected according to their medical expertise, equipment, operational capabilities, and geographical suitability, rather than simply their price. Negotiating a lower price for appropriate treatment benefits both insurers and patients.

Segura also questioned the reliability of AI benchmarking when algorithms rely exclusively on data from existing provider networks. His argument was that cost containment must be based on sound clinical decisions and meaningful comparisons.

Heywood supported this position, insisting that responsible cost management should not be confused with inappropriate care.

Nobody was suggesting that critically ill patients should be placed on the cheapest available flights or that unsuitable providers should be selected purely to reduce costs. Such actions would represent poor decision-making, not responsible cost management.

What we defend is the right care by the right team at the right cost

Heywood stressed that more expensive care did not automatically mean better care. Additional hospital days or unnecessary treatment may increase risks rather than improve recovery. Her closing argument was: “What we defend is the right care by the right team at the right cost.”

The case against excessive cost-cutting

Remmington challenged the growing emphasis on price over quality. Drawing on 30 years of industry experience, she questioned what level of assistance could realistically be delivered through a policy costing just £9.

Remmington argued that assistance is a highly skilled profession, not simply a call-centre function, and questioned whether industry performance measures adequately reflect what happens to patients.

She also criticised the practice of obtaining several repatriation quotes and automatically selecting the cheapest without adequately assessing the provider’s qualifications, capabilities or responsiveness.

Remmington insisted that medical teams should lead decisions, with cost negotiations following the establishment of appropriate care. She warned that continued pressure to cap expenditure could eventually contribute to serious incidents.

Minnis supported these concerns, arguing that financial pressure could influence decisions to the point of potentially endangering patients.

Minnis acknowledged that efficiency improvements were necessary and highlighted the use of AI and more fuel-efficient ambulances within his organisation. However, he stressed that these savings must not compromise safety. “Patient safety must come first, followed by commercial competition.”

Dr Glushak reinforced the importance of clinical judgement through cases involving evacuation, repatriation, and competing medical and financial considerations.

He argued that patient welfare and comfort must remain central, particularly when decisions involve substantial differences in transport costs or medical arrangements. His message was: “Spend the money but do it the right way.”

Dr Glushak also questioned whether administrative processes, including eligibility checks, pre-existing medical history reviews, and liability investigations, could delay emergency assistance unnecessarily.

Although AI can streamline routine processes, he maintained that complex medical cases require individual assessment and human judgement.

Gueye added that financial restrictions imposed by insurers could influence clinical decisions, potentially encouraging premature discharge or limiting treatment options.

He clarified that the argument was not against responsible cost containment, but against reductions that compromise care.

Rebuttal and audience response

During the rebuttal, Segura reiterated that poor decisions should not be confused with cost containment. The appropriate provider is not necessarily the cheapest or most expensive, but the organisation best equipped to manage the case.

Gueye countered that insurers’ financial targets could influence decisions that should remain clinically led. He also questioned whether AI benchmarking systems provide reliable comparisons when their underlying data may be limited.

The discussion highlighted the importance of distinguishing genuine efficiencies from reductions that undermine appropriate treatment.

An initial audience poll found that 56% believed cost-cutting in travel assistance was putting patient safety at risk, while 26% disagreed and 18% were undecided.

Following the rebuttal, revisiting the original question, in the final audience vote, 69% voted yes and 31% no.

The lively debate ultimately demonstrated that both sides shared the same fundamental objective: protecting patients. However, the conversation was shaped by whether cost-cutting itself threatens safety or whether the real danger lies in poor decision-making.

The industry’s challenge is to ensure that financial efficiency, medical expertise, and patient welfare remain aligned, recognising that cost containment is essential but must never become a substitute for clinical judgement.