I studied and compared different HEMS systems, mostly Europe but USA too - it was part mof my thesis some years ago.
I can only say, that US HEMS is, with some bright but rare exceptions, a complete f....k up. Even many hospital based services.
First: fixed costs for such operation are enormous compared to variable cost (cost per mission) Often, it is way over 80% of total cost of operation.
But, under current payment schemes, revenue is generated only per patient transported - this forces providers to take as much patients as possible and this creates two wrongdoings:
- strange arrangements on picking patients (suspicuous criteria for use of helicopters, forcing patients into helicopters, pushing for heli transport of patients, that most of the time, do not need it etc)
-pushing into bad weather to try and transport the (paying) patient as turn back or empty flight does not create revenue -same goes for sitting on the ground and waiting for the weather to improve. Adding to that, some less responsible companies are trying to lower high burden of fixed cost by use of cheapest possible helicopter. Flying a Long Ranger in marginal weather or at night without basic stabilisation, let alone a decent autopilot and even no NVG is a Russian rulette.
Since health care in U.S. is, compared to services in EU, more or less a commodity, sold same way as other services on the market, free market law apply - but with some exemptions, that forces providers to provide service, without knowing if customer is able to pay for it. This leaves them with many bills unpaid as emergency service most often cannot be declined or better to say, service providers are gambling on balance between able and unable to pay customers.
Effectivelly that means that those, able to pay are covering for those that avoid payment one way or another. and that operators are trying to squezze out as much as possible from unaware customers. Those that protest and become loud are potentially damaging to those businesses and often get away with a settlemet - a massive write-off which is, in reality, a fair price.
Just a hint: in Austria, a 15 min flight from ski resort to hospital with decently equipped and staffed EC-135, operated by a pure commercial company will not cost more than 5000 Eur - and they run for profit.
But, since such transports are free market area in Austria, companies mushroomed and sadly, I see some U.S. HEMS trends coming.
My personal opinion: as long as Americans do not want to accept that there are some common issues that need common solutions in a society (or better to say, accept that there is a thing, called "society"), they have to accept the current situation.
Now, fire back.