It really depends on the model being used and the locations. The areas around N. FL are mostly rural and are served by two L1 trauma centers, as well as several other specialty hospitals (think heart/stroke stuff) in the two city centers (Jax and Gainesville). There's also a large hospital in Tallahassee for the more western counties (again, very rural). Peds is the same thing, two major hospitals in Jax and GNV, with the GNV program serving a huge area for Peds.
With two exceptions (and one of them is brand new and no doubt cock-blocking other helos), most of the programs serve the rural areas and bring people into the city centers (and sometimes that means into Orlando, as well). Most of my calls were scene from rural or small city areas, or servicing the prisons. We would get inter-facilities, but my particular base generally does more scene stuff.
In FL, one other thing that happened was that a bill passed several years ago that mandated that traumas had to go to the nearest trauma center. Then-Gov. Rick Scott signed the bill. Low and behold, all of a sudden HCA started putting up L2 trauma centers between rural areas and the L1 centers. And who used to be the CEO of HCA (replaced by his wife)? Yup, Gov. Scott. That was finally stopped after a couple of years, but the damage was done and the L2 centers are still there blocking the L1 centers.
As you have pointed out with the airlines and pricing in the past, it's important to keep in mind how expensive running a base is. Generally speaking, only about 10% of the calls actually pay the price. The rest either don't pay or it's a reduced amount. I used to have the number of what an average base costs, but I've lost it. I think it was ~$5 million a year. An IFR base will cost more than a VFR base.
We'd get the cost question all the time when we'd do PR events. Do people get flown that shouldn't be? Yes, though it's not that often (usually due to inexperience of the ground crew that made the call request or a hospital is trying to do an interfacility and there's no county ambulances). But more often than not, if someone is saying you should be flown out, there's probably a reason. It's also interesting to see how some local hospitals will suck up as much money as they can first before making the call to fly someone out that should have been flown out 6 hours earlier because they were in such bad shape.
