The Cost of Remaining Uninsured

I've come to realize that many people don't know much about medical evacuations. You learn about it when you need to use the service, but that is usually in a time of crisis! So let me tell you a bit about my job.

The reasons for aeromedical transport fall into two broad categories:

• transportation of patients to a center of higher level of care
• repatriation to their home country

These patients range from the stable to the critically ill, depending on the urgency and the level of care offered by the air ambulance service.

I perform aeromedical transport with full mobile ICU-level care. I'm based in Ho Chi Minh City, Vietnam. About 80% of my adult patient transfers are made up of patients that are critically ill but in stable condition (i.e. requiring mechanical ventilation or hemodynamic support). These transfers generally take place after a few days of stabilization and when a fairly lengthy convalescence is envisioned. A lesser percentage, however, is made up of truly unstable patients. These patient transfers are essentially "rescue missions" from areas with less medical expertise, and tend to be life-saving in nature.

Almost all of my cases of aeromedical transport are prompted by insurance companies, with only the occasional private effort. Most tranport occurs from Vietnam to one of the level 3 - trauma medical centers in either Singapore or Bangkok. The remainder are from Vietnam to Australia/ New Zealand/ Japan/ Europe/ Canada. The level of care in Vietnam is not comparable to that found in any of the western countries due to the economic differences.

A not uncommon problem is the patient who travels to Vietnam without traveler/medical insurance. Another frustration involves patients who lie about their medical history on their traveler insurance policy; so when the truth comes out during an unexpected medical crisis, the insurance company denies claims. Let the truth be told; my evacation patients commonly are between the ages of 20 - 65, with past medical problems ranging from none to only high blood pressure or high cholesterol. Diagnoses included: head traumas with severe incapacitation, traumatic pneumothoracis, strokes, heart attacks, multiple organ failure from improperly treated infections at local vietnamese hospitals, metastatic colon cancer previously undiagnosed, newly diagnosed acute leukemia, and so forth.

In view of the current medical technology and expertise found within organizations such as where I work, there are very few absolute contraindications to air transport, and for the most part such transfers can be organized within hours. The impact of air transport on critically ill patients has not been extensively studied, but several studies have looked at the transport of patients shortly following acute coronary events, and have essentially noted an incidence of complications comparable to controls not undergoing transport, and no patients died during transport - essentially concluding that major inflight events are infrequent, and most can be dealt with. This is mostly due to the fact that transport time is short (fixed-wing aircraft) and all but complex surgical and investigational procedures can be performed on board.

Think about the costs for a full-fledged ICU-level aeromedical evacuation; and several days of initial stabilization in a center providing adequate care prior to transfer at your own expense. If you travel uninsured and become very sick, the costs grow rapidly.