Changes to the ambulance system operated by Sun Country Regional Health Authority will have to come from the province and/or the federal government, said Marga Cugnet on Friday.

Cugnet is vice president of primary and integrated health care for Sun Country. She was responding to concerns raised in a letter to the Weyburn Review last week that said the cost of ambulance services to small communities and rural areas is too high, and poses a hardship to low income people when it must be paid upfront.

Cugnet said ambulance costs are frequently discussed at the provincial level but the question is always how to meet the needs of the clients while finding the money.

"When health regions' dollars are already so tight it's difficult to come up with a new plan," she said. "Which program should we take the money from?"

Ambulance costs are not an insured service covered by medicare but they continue to be subsidized by the Saskatchewan government.

As a result, each regional health authority sets its own rates. Sun Country charges $200 for a pickup fee and $2/km thereafter. By way of comparison, Cugnet said Regina charges $250 for its pickup fee even though most of its calls are in the city.

The cost of the service to the region is set primarily by the kind of service provided, she said. Each time an ambulance is called out, whether for a short or long ride, a two-person crew must attend and the collective bargaining agreement requires that they be paid for a minimum of three hours, she said.

In any one of Sun Country's four ambulances, either a paramedic or an advanced EMTA are usually part of the team, which means the higher the training level, the higher the cost charged to the ambulance.

Cugnet said the total annual operating cost for Sun Country of providing ambulance services is about $3 million, of which $1.7 comes from the Saskatchewan government and $1.3 million from user fees. The government also has a special subsidy for seniors over 65 who do not pay more than $250 per ride.

"If the government didn't provide any money, the cost for service would be even higher," she said.

The $3 million total operating cost includes wear and tear on the vehicles and equipment, but does not include the capital costs of replacing any of the ambulances or medical equipment. Cugnet said a typical ambulance can cost $50,000-$100,000, depending on the type of equipment included.

A cardiac monitor can cost up to $15,000, she noted.

Cugnet said Sun Country does require ambulance services to be paid upfront, even when patients are members of Group Medical Services (GMS), but it is considering a system of direct billing to GMS. Some health regions have already changed their system.

But, in the meantime, the region is always open to some kind of arrangement to pay and different kinds of payment plans are certainly available, she said.