Nice Idea, but Who's Gonna Pay?

Ever since responsibility for road accident victims was shifted from the insurance companies to the HMOs, no one has been paying for helicopter evacuations.

A dispute over who pays to evacuate road accident victims by helicopter has thrown into jeopardy the existence of the service, which doctors say is crucial to saving critically injured patients.

Until the end of 2007, helicopter evacuations were performed only by the Israel Defense Forces. Then a company called Lahak Aviation Emergency Medical Services was established, with centers in the north and the south. The site in the south quickly closed down, but the site in the north is functioning and busy, and has evacuated more than 600 casualties since its creation. Most of the people transported - 60 percent of them - were injured in traffic accidents, and the rest were hurt in accidents at work, hiking or elsewhere.

Until 2009, helicopter evacuations were covered by compulsory vehicle insurance, and were paid for by the insurance companies. But this January, the Economic Arrangements Law gave the health maintenance organizations responsibility for care of traffic casualties, and since then the parties have been fighting over who should be footing the bill for aerial evacuations.

Medical helicopter
Hagai Frid

In May, in keeping with a Health Ministry legal opinion, the Finance Ministry insurance supervisor ruled that the Economic Arrangements Law does not free the insurance companies of responsibility for aerial evacuations, and they must continue paying.

The Israel Insurance Association appealed the ruling. The appeal was rejected, but the insurance companies are still refusing to pay. The association argues that the IDF would evacuate only 10 to 15 casualities a year in the north, and the fact that a private company is evacuating hundreds of casualties annually might indicate that many are unnecessary.

Lahak Aviation said it evacuates casualties only at the request of the Magen David Adom emergency services. The company has asked that the Knesset Health Basket Committee discuss including its services. Deputy Health Minister Yaakov Litzman refused, because he "believed it is inappropriate to pay for this service with the basket's funds," the ministry said. However, the ministry's new director general has agreed to re-examine the request.

The assumption underlying aerial evacuation is that getting a victim to a hospital within 60 minutes - the "golden hour" - might well save his or her life.

Two committees have decided that aerial evacuation needs to be an option in Israel: a Transportation Ministry committee in 2006 and a Health Ministry committee in 2009.

"The fact that the existence of the service is in danger is a scandal," said Shmuel Abuav, director general of the Or Yarok Association for Safer Driving in Israel.

Meanwhile, Lahak isn't getting paid.

"We evacuate casualties without getting payment," said the company's co-director general, Ron Ben Moshe. "If the problems aren't solved, we will have to start using the helicopters for other purposes."

The insurance association says the insurance supervisor's instructions contradict the Economic Arrangements Law, which intended to transfer the cost of caring for accident victims to the HMOs. Instead, the companies are being required to pay the HMOs for both their medical care and also for the helicopter evacuations, said the association.

For its part, the Finance Ministry says: "The insurance supervisor has told the insurance companies that the shifting of responsibility for road accident casualties does not mean they are not responsible for covering helicopter evacuations."