Having worked on projects with public hospitals over the past few years, I got a taste of how complicated their funding is and how difficult their jobs are in taking all patients regardless of ability to pay. In these lean times, healthcare costs keep getting pushed further down the food chain. While most public hospitals have a sliding payment scale dependent on ability to pay, and they accept private insurance, the vast majority of patients come in via Medicaid or as indigents without even Medicaid as a provider. The mission of public hospitals–to provide for everyone–is in direct conflict with their ability to keep a firm hand on the bottom line.
According to the Wall Street Journal, the trend is to turn over management to for-profit hospital chains. While this arrangement certainly removes many of the local political pressures from public hospital boards, it may also lead to hospital closures and more restricted access to care, especially in rural areas. De facto rationing of healthcare?