Private/for profit EMS
Ambulance services operating on a private/for profit basis have a long history in the U.S. Often, particularly in smaller communities, ambulance service was seen by the community as a lower priority than police or fire services, and certainly nothing that should require public funding. Until the professionalization of emergency medical services in the early 1970s, one of the most common providers of ambulance service in the United States was a community's local funeral home. Funeral home ambulance operations were sometimes supplemented by 'mom and pop' operations, which weren't affiliated with funeral homes but rather operated on much the same basis as a taxi service. Such companies continue to operate this way in some locations, providing non-emergency transport services, fee-for-service emergency service, or contracted emergency ambulance service to municipalities, as in the public utility model. During the late 1970s and early 1980s, more than 200 private ambulance companies in the U.S. were gradually merged into large regional companies, some of which continue to operate today. As this trend continued, the result was a few remaining private companies, a handful of regional companies, and two very large multinational companies which currently dominate the entire industry. These services continue to operate in some parts of the U.S., either on a fee-for-service basis to the patient, or by means of contracts with local municipalities. Such contracts usually result in a fee-for-service operation which is funded by the municipality on a supplementary basis, in exchange for formal guarantees of adequate performance on such issues as staffing, skill sets, resources available, and response times.
http://en.wikipedia.org/wiki/Emerge...in_the_United_States#Private.2Ffor_profit_EMS