Medical repatriation and reputation: the travel insurer dilemma


How does cost affect medical repatriation?

There’s no question that a policyholder’s wellbeing must come first and foremost when the right course of medical assistance or repatriation is arranged following an accident or illness. But the power of the media – and social media – can sometimes put customer-facing teams in the firing line if there’s a perception that the ‘right’ decision hasn’t been taken. Indeed, sometimes ill-informed media headlines cite cost-containment as a reason for a patient not being repatriated. Yet the reality is that the individual’s condition and circumstances should drive the medical decisions, not cost.

Everything we do at Healix is focused on the welfare of the patient and their specific situation. We need to consider the illness or injury they are suffering from, the quality of the medical facilities on hand and the implications and logistics of moving them. If there is a possibility that moving a patient could cause harm, then we have to balance that risk with the risks of allowing the patient to remain in a location where medical facilities may be less than ideal.

All our international patient transfers are tailored to the medical needs of the patient and will sometimes go well beyond a standard air ambulance evacuation.

Our role is to consider what’s wrong. What’s the degree of severity? What is the quality of care like? Are we happy with the care the patient is receiving? And at the heart of making those assessments is the quality of information we receive.

Medical repatriation: chain of events

Typically, the chain of events of a medical repatriation begins with a phone call. If someone has been hit by a car, for example, the call might come from a work colleague or a family member who was on the scene. They might be able to provide useful information. However they are likely to be in a distressed state, in need of help themselves and not in a position to give us the details we need.

The priority, therefore, is usually to talk to the medical team in the overseas hospital to get a clear understanding of the patient’s situation. At the same time we work behind the scenes to assess the quality of medical care available locally and whether or not this meets the patient’s needs.

Our global knowledge means we have a good understanding of how medical capabilities vary – not just from country to country but from city to city and hospital to hospital. In some cases we have to advise that the medical care is sub-optimal, even when the treating doctors overseas are painting a favourable picture. The right course of action depends on the medical prognosis as well as the quality of care.

For example, the decision is easy when assessing someone who is developing multiple organ failure in Chad. We have to evacuate him or her to a centre of excellence. But someone with the same condition in a country where the medical facilities are below Western standards but yet still able to treat the patient (e.g. Belarus) is a more complicated scenario. Moving the patient might be hugely risky if their condition is unstable. We have to decide if it is it better for them to stay there. We have to balance the two risks.

When is an air ambulance appropriate for medical repatriation?

The other issue is where the patient should be taken. The medical condition is our primary concern so, for example, if we are looking after a patient who has experienced a serious trauma in Bali, we would probably look to get them initially to Singapore or Bangkok which both have centres of medical excellence, rather than risking a long-haul transfer before they were fully stable.

Once the decision is made it is crucial to take the time to communicate the thinking behind our recommendations to concerned relatives. Sometimes that means explaining that every option open to us carries risks which we may not be able to quantify with certainty.

The other challenge is the way in which a patient should be repatriated to their home country. Patients often express a desire to be flown by air ambulance. But if you’ve ever been in an air ambulance, you wouldn’t choose to fly that way. The interior is a desperately uncomfortable, cramped working environment. You can’t stand up without bending over. There’s no food except what you bring with you. No movies. No cabin staff. What’s more, most of them have to land and refuel every four hours.

Air ambulances are used only for emergency evacuations or for cases where patients are simply not well enough to be moved on a scheduled flight even with a medical escort. Most patients will be much more comfortable flying on a scheduled flight where a nurse or a doctor (or both), together with in-flight medical equipment, will accompany the patient so that they can be cared for properly during the journey. Patients will usually be accommodated in business class which on long-haul flights affords a high degree of comfort. On some airlines it is possible to accommodate stretchers so that patients who are unable to sit in an airline seat can still be transported.

There are no rules in international medical assistance. No two cases are the same and each must be assessed on its individual merits. The skill of the international assistance medical team is to understand the specifics of a case and tailor our recommendations to fit, ensuring the best possible medical outcome for the patient.
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