The Steamship Authority this week decided to charge more for ambulances taking patients off-Island for treatment.

And the fare increases, which will take effect from Nov. 1, will be steep — nearly 100 per cent on some trips from the Vineyard and more than 100 per cent for some Nantucket trips.

Currently, the SSA charges $102.50 per round-trip for ambulances on the Vineyard route, and $215 on the Nantucket route. The price includes the fares of the driver and passengers, and there is no extra fee if the ambulance is over 20 feet long.

Once the changes come in, though, the cost will rise to $200 for some ambulances from the Vineyard, and $461 for some from Nantucket. The new fares will be in line with what the SSA charges for similar-sized commercial vehicles.

The cost will vary according to the time of year a patient gets sick or injured, and the size of the ambulance needed to transport them.

If you are a Vineyard resident lucky enough to need only a small ambulance between the start of November and end of March, the fare rise will be slight. It will go to $105. But come the start of April, and through to the end of October, the rate will be $155.

If you need a bigger emergency vehicle — probably because you are sicker or more seriously injured — the cost goes up 50 per cent to $165 from November through March. And should your health crisis occur during the high season, it goes up again, to $200.

Still, it’s a lot cheaper to be unwell here than on Nantucket. The comparative rates there are $300 for an ambulance under 20 feet in the low season, and $430 in the high season, and $309 for a larger ambulance in the low season and $461 in the high.

The increases will generate a tidy sum in extra revenue for the boat line, and most of it will come from the Vineyard route. During the 12 months to June 30 this year, the boat line transported 1,415 ambulances, 1,358 from the Vineyard and just 57 from Nantucket.

“It represents an average of almost four ambulance trips per day, or two ambulances per day in each direction, with slightly higher volumes in the summer months,” the SSA staff summary said.

By far the largest single user of the SSA for ambulance transports is the Martha’s Vineyard Hospital, which initiated 1,047 trips during the year to June 30.

Having increased the take from the sick, SSA governors moved on to consider ways to increase revenue from the indigent, through a proposed credit card.

The idea of a so-called affinity credit card is being pushed by Nantucket governor H. Flint Ranney. He suggested the SSA could do it in association with the Martha’s Vineyard Savings Bank.

But the idea met with some concerns on the part of SSA general manager Wayne Lamson and a couple of other board members.

First, Mr. Lamson said, the cards might not generate much money, given the recent tightening in access to credit. People who had cards tended to pay off their balances to avoid paying interest, and people who could not afford to do that often had trouble getting cards.

And if the SSA made money from such a plan, it would be from people who did not pay off their balances each month.

Mr. Lamson said his preliminary discussions with the bank indicated the bank was willing to offer two per cent of the income generated from the cards to the SSA. So if the normal interest charge was 15 per cent, it would be 17 per cent on SSA affinity cards, and they would get two per cent of any money made on carried-over balance.

Thus no money would be made from people like Mr. Ranney, who proudly told the meeting he paid his Mastercard off every month. But it would make money from people whose cash flow did not permit that.

Mr. Lamson asked if from a policy standpoint that was something the authority should get involved in.

But Mr. Ranney persisted in his idea, which he jokingly called a “frequent floater” card.

He optimistically envisioned “a couple of million people who are candidates” for such a card.

“I hate to let sleeping dogs lie,” he said.

Other governors also questioned whether it was part of the purpose of the SSA to encourage people, as one put it, “not to pay their bills.”