Treatment and evacuation options in the Caribbean
Fiona Keating explores the considerations and challenges of assisting patients who find themselves needing medical care while visiting the tropical archipelago
Tackling medical emergenciesoverseas involves particular challenges, and insurers and medical providers are essential in providing a calm, rational and fast response for clients who are thousands of miles away from home, with a potentially life-threatening condition. This is no less true in the Caribbean, where it is important to consider the set-up in each of the islands in terms of medical treatment and evacuation options. The Caribbean islands have various medical facilities, ranging from basic clinics to larger, more advanced hospitals with specialised treatments and procedures. Not every island has the same level or expertise in medical care, which can mean evacuation to another island with more advanced medical facilities.
“While there are no prominent centres of excellence throughout the region, there are a few options that stand out,” said Natalya Butakova, CEO of AP Companies.
AP Companies provides its members with access to medical providers in 185 countries. Its medical provider network includes ground ambulances, hospitals and specialised medical units.
Some countries and territories have more advanced medical facilities than others. The Cayman Islands, said Butakova, is ‘known for its exceptional quality of care’, with a comprehensive range of medical services and a reputation for excellence. However, because of this, healthcare costs in the Cayman Islands can be significantly higher than other options in the Caribbean. Butakova also stressed that ‘they carefully screen potential patients, and may not accept all cases’.
Barbados is another Caribbean nation that provides high-quality medical care – but because of this, the costs can be relatively high. The island, located in the Lesser Antilles, has specialities in general surgery, gynaecology and urology. However, explained Butakova: “Specialists in fields like neurosurgery can be challenging [to find]. So, identifying the client’s medical needs beforehand can help in choosing which country to opt for in terms of treatment, rather than [resorting to] evacuation back to their country of origin.”
The closest viable option for evacuation from the Caribbean is usually the US. This can incur substantial costs for both the evacuation itself and subsequent treatment. Evacuation coverage is particularly important, because an ambulance flight can easily cost $15,000.
Cost-effective treatments - Repatriation or evacuation decisions
Repatriation on a commercial flight is usually a more cost-effective solution than using a private air ambulance, although patients will need to wait for the availability of a commercial plane.
The advantage of travelling by air ambulance is that patients don’t have to wait for a commercial flight, and an air ambulance can be ready for take-off much faster. A dedicated medical flight is usually possible either on the day, or the day following the booking.
Some patients may prefer to return to their country of origin for medical treatment. US citizens, for example, may not be satisfied with the quality of care in the Caribbean, compared with facilities such as the Mayo Clinic, Cleveland Clinic or Johns Hopkins.
With conditions such as cancer, heart disease, stroke or diabetes, returning home also allows patients to be treated by their own doctor, who will have access to medical records and can tailor treatments according to the individual.
US citizens ... may not be satisfied with the quality of care in the Caribbean
However, if the patient is a European Union (EU) citizen and fit to fly, it is usually recommended to repatriate them to their home country. “By doing so, the quality of care can be guaranteed, and the patient can receive assistance within their local healthcare system without the burden of treatment costs,” explained Butakova.
The ability of international assistance companies to access local prices varies according to the country. AP Companies has a comprehensive process for empanelling a new medical provider, and checking the suggested price list for rates is part of it. The group uses several techniques to determine if the price list provider is offering AP Companies its local price list and to secure local rates for the contract. If local rates are not an option with a specific provider, then the company looks for alternative options in the region.
Technology is increasingly important. AP Companies’ automated cost containment tool identifies any deviations from local rates, even if the provider decides to implement any co-efficient later on. Butakova said: “This need, of course, is being driven by the volume of members and cases we have in the area, but has proven to be very successful lately.”
In some countries in order to get access to local rates, they work with local representations in order to be able to make payments in local currency at local level. While hospitals may naturally view foreign patients as an opportunity to maximise billing, Butakova says it is their role as an assistance partner to minimise medical costs and generate savings for their clients.
“What we have noticed is that medical providers would be more reasonable and careful when billing their regular patients – those are expats and patients who are based in the country and use their services on a regular basis,” she explained. Butakova also noted that providers ‘tend to have a larger average bill when it comes to travellers and tourists who end up being in the hospital and will probably never visit it again after finishing their treatment and travelling back to their home country’.
For European insurers, it is a viable approach to transport patients to EU territories, allowing them to access quality care at reasonable costs through EU reciprocal health agreements. This strategy not only helps contain costs but also provides patients with the opportunity to receive treatment in their home country, in a familiar environment, with language support and the presence of their family – all of which can improve patients’ mental health and recovery times.
“AP Companies thoroughly evaluates each case and the patient's medical condition,” said Butakova. “If it is feasible for the patient to be transported back to their home country, we recommend this option as preferable to our clients.”
Remote healthcare vs in-situ high quality care
Since the Covid-19 pandemic, telemedicine has gained significant importance and popularity among travellers. Many travellers prefer teleconsultations when they require medical prescriptions or basic GP consultations for common complaints such as colds or influenza.
Telemedicine offers travellers the convenience and efficiency of receiving medical care in the comfort of their hotel room, eliminating the need to spend time reaching the medical provider, and waiting to be attended. AP Companies has introduced a localised telemedicine service, enabling patients to consult with local doctors who can prescribe locally available medications. This ensures that the prescription will be accepted by local pharmacies, and the quality of medical service is guaranteed.
“Telemedicine has its advantages in terms of convenience, accessibility, and reducing unnecessary physical visits,” Butakova said. “However, it does have limitations when it comes to certain complex medical conditions that require in-person examinations and interventions. But it still remains a valuable tool for initial patient triage and helping to maintain health where medical care might be limited.”
many travellers prefer teleconsultations when they require medical prescriptions or basic GP consultations for common complaints such as colds or influenza.
In situ treatment – quality of care matters most
Diane Heckel, CEO and founder of West Indies Assistance, is confident of the level of care in the Caribbean, as many of the doctors have been trained in France. Located in Martinique, the company provides repatriation, medical evacuation and medical concierge services. It also has facilities in Guadeloupe, and has developed several local partnership agreements.
“I try to make our hospitals in Martinique and Guadeloupe popular among Europeans in case of emergency treatment, so that means you don’t pay for extra medical expenses,” Heckel said. “We have so many tourists. In the Caribbean in 2022, 43 million people visited because this region recovered the fastest from Covid-19.”
In terms of what visitors from different countries expect, in her experience, Heckel explained that Americans tend to go straight to Miami for treatment. “They don’t stay very often to get surgery on the Caribbean islands.”
Heckel noted that there is a tendency for the British to stay on the islands for medical treatment in public hospitals as the cost is lower.
In terms of repatriation, Heckel uses commercial flights, for example through Air France, which are equipped with oxygen and stretchers. The medical teams can intubate and transfer patients from Martinique to Paris, and then to London or Berlin.
“I would recommend that if you have a heart attack, stroke or need heart surgery, that you go to Europe for more advanced, special treatment,” argued Heckel. “If the patient is declared fit to fly by the treating doctor, they can travel on a stretcher or with oxygen on a commercial flight, or in business class with a doctor. The doctor will decide whether the patient is fit to fly or needs to stay in situ for treatment.”
Heckel does not hold with the view that hospitals see foreign patients as an opportunity to maximise billing. “The hospital is not trying to make money off your back, because it’s a public hospital – and they want the patient out as soon as possible because they need beds for the people from Martinique.”
West Indies Assistance has an arrangement with the University Hospital of Martinique, which offers a range of medical services to accompany the patient from their point of departure to arrival in Martinique and throughout the scheduled stay in hospital. The company also collaborates with the University Hospital of Guadeloupe, the Saint Paul Clinic in Martinique and the Eaux Claires Clinic in Guadeloupe.
The company reports a rising demand for medical evacuation services between Caribbean facilities. The West Indies Assistance finance and administration department continually reviews and monitors expenditures. The price of a medical repatriation and hospitalisation at the University Hospital of Martinique can vary according to the means of transport chosen and the medical treatment needed. These costs can amount to tens of thousands of euros depending on the origin and destination.
The rate will depend on several factors, including the patient’s health status; whether they have a European Health Insurance Card (EHIC) or UK Global Health Insurance Card (GHIC); the urgency of the situation; the duration of the flight; the presence of a qualified medical team and sufficient equipment; and the chartering of a medical aircraft.
Growth areas and opportunities
The needs of the market are now adapting to the post-pandemic world, with more players coming into the market, a spokesperson for Helidosa Aviation Group explained. With a strong foothold in the Dominican Republic, Helidosa is now in its 31st year of providing air ambulance transport, and is also a popular choice for possible evacuations from Haiti. The company is now looking to expand its horizons, and moving into the global market, working with large assistance companies.
The Helidosa spokesperson highlighted developments in the Cayman Islands. “They have grown their infrastructure,” they said. “They are doing a big push as a health hub and the backdrop to this is investment from India. A hospital chain from India is looking towards the islands and also reaching out to health speciality procedures at a lower cost for North America. For me, these are the new kids on the block.”
The needs of the market are now adapting to the post-pandemic world, with more players coming into the market
There are other changes that Helidosa has noted since the Covid-19 pandemic. “Prices have gone up, such as landing prices at some airports. There is definitely an increase in prices across the board. It could be a tactic to financially recover – we don’t know. There should be some kind of logic, but we haven’t found the reasoning behind this.”
Helidosa is preparing for the future by readjusting and planning to become more responsive to this fast-changing market. “We are in the process of streamlining our fleet. We had a big range of sizes and types. Now we are specialising towards a more efficient size and type of aircraft. From five types of aircraft we are moving down to three, probably. Moving away from rotor-wing operations, we are reducing to just keeping the medical helicopters and moving away from charter airlines.”
The use of larger-capacity aircraft means that Helidosa can transport multiple patients onboard at once. “We have two aircraft that can transport two patients at a time. I know other operators in the industry invested heavily in the Challenger aircraft, which also has the capacity for multiple patients.”
Supply chain issues are also affecting the replacement of aircraft parts. “During Covid-19, we were looking for tyres for one of our airplanes, a Gulfstream IV, all around the world, because the manufacturer said there was a hold of a year and a half,” the spokesperson added.
Offering a reliable and fast response is the number one priority, as is assisting clients to make the best decisions for their health and safety. Providing additional services, working with local providers and offering competitive rates will improve customer loyalty and retention, and attract new customers.