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You’ve heard about heart transplants, prostate surgery and heart attacks. You probably have never heard of an air ambulance, until now.

A sharp decrease in infections at a Russian mental health hospital forced the hospital to buy a used air ambulance to transport patients to three other facilities, according to a Reuters report. One patient’s costs even exceeded $52,000 because he needed radiotherapy.

“I went to see a doctor, who has worked at the hospital for 40 years, and he said, ‘Now I can’t accept your tests. They were too expensive,’” said Artyom Utkina, an IT specialist at the former Institute of Psychopathology in Moscow. “At that point, I understood that it was the hospital’s money that I was paying for these tests and I have a doctorate, so I asked the doctor to write a check for me.”

Transporting the patient to Minsk cost $29,000 and to Donetsk and Lugansk, the patient paid nearly $30,000. The patient stayed at a hospital in Moscow until the Soviet-era air ambulance was repaired and re-used.

Utkina and the rest of the inhabitants of the former mental institution now care for 50 people, including many who were ill from the disease that drove them to the former mental hospital. Although different companies rushed to repair the medical equipment, none wanted to buy the air ambulance because the price tag was too high.

The Russian Ministry of Health sent in air ambulance services to transport patients, but only after patients started falling ill. The ministry later reimbursed the cost of each trip, including the fee charged by the two air ambulance firms contracted by the psychiatric hospital, Utkina said.

Other patients did not get immediate help and went in critical condition to a flight to Ukraine, Utkina said.

But Utkina and the hospital said they are not looking for any payment.

“Please understand that this is a social thing. A person who suffers from acute psychiatric disease or torture cannot be expected to buy his treatment,” said Alexander Garibov, the director of the former institute. “What was said is blatantly unfair. The new patients are going to pay for it at the end of the year.”

Doctors have tried to give these medical tourists something of a discount. But they are not provided with money or direct cash transfers for transportation.

“All doctors who were looking after patients, especially those with a sort of depression, alcoholism or mental illness, are now not allowed to work in the mental hospital for one year. That is the reason why people are turning to [the] more expensive hospital services that were previously impossible to afford,” said Vladimir Karabayev, the doctor who first saw the low numbers of patients at the mental hospital and urged the hospital to purchase the air ambulance.

Utkina said he decided to contact other doctors in the area and arrange a professional group for air ambulance flights. The air ambulance company said they could save the hospital millions if it were to carry other patients.

“The central bank keeps a list of bailout requests they have received over the past year,” said Carole Billie-Roy, an economist and senior fellow at the Center for Global Development. “As soon as hospitals find out about them and get them in their budget for the next year, the central bank says, ‘OK, you can’t get one more patient from a central hospital to another central hospital.’

“It’s like a kangaroo court hearing where all the creditors at a hospital are collectively deciding who gets what: the creditors versus the patients,” she said.

In the early 2000s, the World Health Organization reported that air ambulance services cost about $70 million a year. Although the number of air ambulance flights has fluctuated in recent years, the report estimated the sector’s net revenue hit $30 million. The WHO study also did not include the costs of hiring a driver or of rescuing patients.

In Russia, Utkina found out he could get the earlier air ambulance service, which used a smaller twin-engine aircraft, for $11,000. He claims that the team offered to fly him to Tbilisi for treatment, but his doctor told him that the hospital could not afford the plane tickets.

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