and a less robust, comprehensive air ambulance availability  

 strength is not in saving lives, it is in reducing mortality, a far more expensive proposition.  

The industry could be down sized some if medical providers endeavor to put in service more ground ambulance capability, tele-medicine, and robotic surgery.

The oddest thing I ever saw in the air ambulance arena was doctors waiting close to their end of shift to call for air ambulance transport to a higher level of care.  Given those shift start and end times are fairly standard in the industry transport bottle necks needlessly arise.  

Study that and get the doctors under control and high utilization times demanding the presence of more air ambulance might just help resolve costs.

But, all probably too complicated considering doctors are considered off limits.  My FAA Medical Examiner commented to me that he can do whatever he wants to with respect to releasing pilots back to service - wrong.

Lot of arrogance in that community.