Health care reform and air medical transport services.

American medical centers provide, at significant operating losses, air medical transport services to improve trauma care and interhospital transfers. These programs are cross subsidized by the publicity that encourages high-payer classification patients to seek out these facilities for their tertiary services. This article argues that as American health reform focuses more on constraining costs and as more belt tightening is needed, health managers and physicians will prefer giving up their "flying billboards" rather than their sophisticated tertiary services. It is proposed that, because of fiscal constraints, we might be forced to use the Australian or German Emergency Medical Services (EMS) model. This approach would require that we spin off the air medical transport and ground ambulance services from their present governance structures, and manage and fund these programs directly through statewide EMS-type governing boards with their own chief executive officers and staff.