Reimbursement
Public programs such as Medicare and Medicaid, as well as private payers, continually look for ways to reduce the amount of money paid to providers for services that inextricably get more and more costly due to inflation and technological advances. These reductions or leveling in reimbursements, coupled with increasing numbers of uninsured and under-insured, create a difficult environment in which to meet the public's need for adequate, yet affordable health care.
Our finance reports provide a view of the complex system of hospital finance and keep explanations of what factors influence hospitals' ability to deliver upon their mission, and how payer and service mix affect hospitals' financial viability.
How Are Hospital Services Paid For?
The bulk of a hospital bill is not paid for directly by the patient (self pay*), but rather by an entity that provides health insurance, commonly termed "the payer". In the US, third-party payers fall into two main categories: private and government.
- Private Payers
- Government Payers - Medicare and Medicaid
- *Self Pay - This group of payers does not have private insurance, does not qualify for government programs and tends to include a large portion of the working poor.
