| It's very expensive, carriers have an economic incentive to simplify it and this is still where they end up. There are a long tail of provider circumstances that the single-payer model will need to figure out. Some examples: * Small hospitals in low-density, underserved areas have to make up for underutilized equipment and personnel costs. They raise prices on unrelated, common procedures to break even (This is very common) * CMS (medicare/medicaid) sets a low price for a procedure that's overly common in a particular facility, now that facility loses money for each occurrence. They choose other procedures to raise the price to try to break even. * Larger hospitals have higher administrative and operations costs (for things like training and research) that benefit society, but need to be averaged out across all procedure costs. This differs from hospital to hospital. * Smaller professional facilities or physicians groups (like Ambulatory Surgery Centers) have much lower administrative costs and a smaller staff, so they have lower overhead per procedure. They are designed to be efficient, and can handle lower prices. However if there are any major complications, they won't be able to service the patient, and have to send to a hospital. This then pushes all the highest-cost, ICU-type procedures into hospitals, where there is already a higher overhead, causing hospitals to need separate pricing to cover more complex patients. A large single payer price set will probably force efficiencies into the healthcare system. It'll be great for folk's costs, but we may see many facilities close, and lines of care will be consolidated into specialty centers. (more travel to get imaging, procedures, or to see a specialist) |