There is ALWAYS a profit consideration
whether it's public service/government, "not for profit", charity, or a conventional for-profit business model. The profitability is determined in different ways that makes it harder for people to see the decision points.
Public service/government will use a limited budget (hopefully) to provide the best value, another name for profitable application of resources. If the budget "Super Bug Smasher" law enforcement/air ambulance is not justified by providing "x" number of transports to the public at large, that budget will be redirected to something else. There aren't limitless funds, even in enlightened Europe- do you see many air ambulances with flight into known icing capability over yonder? No? I would think it would be very useful...
Not for profit... same-same, only cash flow can be directed to various entities as equipment, salaries and bonuses, whatever makes the bottom line all 'zero-ey". I can't count the number of not-for profits gone belly-up because of what is termed poor profitability in a conventional business scenario.
And finally, the much maligned "for profit enterprise"- Efficient application of resources required or you fail. HEMS/HAA or whatever the PC term is this week can be done safely by a for profit, witness the current airline industry compared to earlier for an idea of possible room for improvement. As in any operation, HEMS/HAA management for safety requires proper prioritizing and management of resources. THAT is not routinely done in the US, Gomer Pylot brings up some of the issues. It's not that management intends to compromise operational safety for profit, it's that they don't SEE the factors acting to increase risk. Another example of that issue as I see it- None (zero, zilch, nada) of my company's management fly the job, ever. All of my company's instructional staff are management. Even my chief pilot, for whom I have great respect, has a historic and dated view of the job and challenges faced.
Another example from night problems in the US HEMS/HAA industry- pilots plan on sleeping on the job (for various reasons, not germaine) and do so. Now at Oh-dark thirty, the request comes in, awakens the pilot, the pilot checks weather and compares METARs to forecast while awakening the crew (response time isn't the criteria except that it IS tracked and used to critique). What was missed that is really, really important? trends. You have to monitor trends to have any real idea of weather. Forecasts are guesses, observations are history, trends show where the weather will probably be going in spite of forecasts...