Adequate mental health service provision in rural and remote Australian communities is problematic because of the tyranny of distance. The Royal Flying Doctor Service provides air medical retrieval for people in rural and remote areas. The economic impact on both the Royal Flying Doctor Service and the public hospital system for mental health–related air medical retrievals is unknown. We aimed to estimate the direct medical costs associated with air medical retrievals and subsequent hospitalizations for mental and behavioral disorders for the 2017 calendar year.
Approximately 29% of the Australian population lives in rural or remote settings.1 The prevalence of mental health conditions in rural and remote Australia is comparable with inner regional and major city areas2; however, the burden of disease is far greater for people living in rural and remote settings.3 , 4 This is most clearly demonstrated by suicide rates, which increase in line with the degree of remoteness, ranging from 9.4 per 100,000 persons in major cities to 18.1 per 100,000 in very remote settings.5
Although the drivers of this unbalanced burden of mental health conditions are many and complex, 1 of the key factors is the supply of mental health services. The majority of mental health professionals, measured as full-time equivalent (FTE) per 100,000 population, are located in major cities.
In addition to these supply-side issues, demand for mental health services differs from that in major cities and many urban centers. Although the overall prevalence of mental health conditions is similar across settings, people in rural and remote settings experience higher rates of substance use and acuity of mental health conditions along with the aforementioned rates of suicide.8 , 9 Furthermore, increased environmental challenges including drought, fires, and climate change, and the recent Coronavirus pandemic, are placing greater pressure on the mental health of many rural and remote communities.10, 11, 12, 13
In this context, the Royal Flying Doctor Service (RFDS) provides air medical retrievals for Australians living in rural and remote communities experiencing health crises, including acute mental health presentations. Patients are typically transferred by aircraft to large metropolitan or inner regional public hospitals for urgent acute care. The economic costs of this approach, including those incurred by the RFDS and public hospitals, has not been quantified.
Results
One hundred twenty-two primary evacuations and 926 interhospital transfers occurred with an in-flight diagnosis of F00 to F99, most commonly psychotic disorders, including schizophrenia and schizotypal disorders. The total direct medical costs were estimated to be AUD $20,070,527. Costs for primary evacuations accounted for 13% (AUD $2,611,260), with the majority of this associated with the subsequent hospital admission (AUD $1,770,139). Similarly, the majority of the costs associated with interhospital transfers (total costs = AUD $17,459,267) were also related to hospital costs (AUD $13,569,187).
Conclusion
Direct medical costs associated with air medical retrievals for people experiencing a mental health crisis are substantial. The majority of costs are associated with hospital admission and treatment; however, the indirect (loss of productivity) and intangible (quality of life) costs are likely to be far greater.
Gardiner FW, de Graaff B, Bishop L, Campbell JA, Mealing S, Coleman M. Mental Health Crises in Rural and Remote Australia: An Assessment of Direct Medical Costs of Air Medical Retrievals and the Implications for the Societal Burden [published online ahead of print, 2020 Jul 15]. Air Med J. 2020;doi:10.1016/j.amj.2020.06.010
