Officials in the Commonwealth of the Northern Marianas are looking at what options are available to them now that Continental Airlines has decided to end its Saipan to Manila service.
Continental says a dramatic hike in fuel costs and low sales was the reason for the cut.
This will limit access to specialised medical care for locals sent to Manila.
The Public Health Secretary, Joseph Kevin Villagomez, says Continental planes are equipped to carry stretchers and patients with oxygen.
Dr Villagomez also says the other key advantage was the duration of the flights.
"There is still a way to get to Manila via Japan or Korea but the problem is the transit time is quite long, and if it's a seriously ill patient, what normally would have taken 3 hours to Manila with the direct flight, it can now take up to 15 to 20 hours."
Dr Villagomez says there are hopes another airline may step in.
For the past five years, the CNMI has been sending at least 200 patients a year to Manila.