In 2006, some 40 foreign tourists were involved in a bus crash in Heilongjiang in northwest China. One was killed and 28 were injured. The victims were transported by local emergency personnel to a nearby city with minimal medical capacity, no official airport and none of the customs services required to get expatriates directly home for further medical treatment.
Fortunately, the group had evacuation insurance through International SOS (ISOS), a Singapore-based provider specializing in expatriate coverage. The company used a dedicated medical jet to evacuate the victims.
While such incidents are relatively rare, they continue to happen. Last year, ISOS took on 414 medical evacuation cases in China, many related to the Sichuan earthquake.
"Anything can happen at any time," said Kirsten Raynal, business development executive at Panoramic Insurance Brokerage in Beijing (PIB). And when it does happen, China can be particularly inhospitable: "Often ambulances are unreliable, and people are not accustomed to helping strangers."
Raynal finds that evacuations are increasingly rare, though. Chinese medical facilities and services have improved dramatically, reducing the need for expats to return home for care.
"Chinese medical facilities in major centers such as Shanghai and Beijing are adequate for almost all eventualities," said Steve Conway, head of the local health care division for AXA-Minmetals Assurance. "These facilities can be intimidating, but we provide physicians and translators for the patient and their family."
In fact, according to Raynal, most evacuations can be handled domestically, without resort to specialized medical evacuation aircraft. "Places like Inner Mongolia may get you a private jet if there are no other facilities," she said, "but now that China has developed a lot, it is really rare to get a specially hired airplane."
Most evacuees, in fact, fly business class. This may seem like a slow and less comfortable way of being moved, but Conway of AXA-Minmetals said that it is often the safest and most practical way to go. AXA-Minmetals, which insures some 5,000 expatriates in China, uses First Assistance, an Auckland-based third-party provider, to handle its medical evacuations, but First Assistance rarely requires private jets. Instead, patients are generally provided with two or three seats in premium class and may be accompanied by a nurse, doctor, friend or family member.
This saves money and frequently saves time. A private jet from Shanghai to Hong Kong, for example, costs US$25,000, but may not provide any better treatment along the way. For these reasons, AXA-Minmetals has not used a private jet for evacuation in three years, Conway said
Patients with access to direct commercial flights can get quick transportation to cities with international standard treatment facilities. "In the time it would take to mobilize a private jet," said PIB’s Raynal, "a patient could leave from a hospital in China and arrive in one in Hong Kong."
However, Dr Robert Allen, regional medical director of ISOS North Asia, disagrees that evacuations are declining. The number of expatriates the company evacuates year to year has remained about the same, he said. This is not necessarily due to the quality of medical care provided in China, as Allen agrees that there is often less of a driving need to move patients out of China.
However, psychological comfort is at times a medical factor, and some patients are simply not comfortable being treated in Chinese hospitals – as Conway puts it, the facilities can be "intimidating." Also, children can be special cases. Not only are most expat parents less willing to experiment where their children are concerned, but many doctors at international clinics in China lack the certification to operate on children.
"At the end of the day, evacuation is not necessarily about what is available locally," said Allen of ISOS. "Sometimes it’s better for patients to get treatment in an environment they are most comfortable in."