Where does all the money go?

[everydaynurse]

I was a patient recently, and I now realize how expensive a prodcedure can be. I also realize as a nurse how much we get paid. It really seems complicated when you look at all the costs in running a hospital. Are there really deficets? I know health insurance is a slow death to a lot of industries. So are hospitals like some other corporations, big salarys on top and to home office?

[BlueDevil,DNP, DNP, RN]

There is a great deal of cost shifting going on, but one must be careful not to attribute a $4 tylenol tablet to fraud or avarice. Regarding the salaries of CEOs, consider that there are relatively few people capable of running a hospital system but an innumerable number of people wanting to work within one. That they are paid so highly for their work while the rest of us are poorly compensated for ours is pure post-Keynesian economics. It isn't a conspiracy, it's the economy, stupid.

[EMP, RN]

besides the things other posters mentioned, you are also paying for the people that come into the hospital and don't pay and don't have insurance and for all things that medicare or medicaid don't really cover the total cost on. Legislators haven't seemed to figure out (or don't care) that if they decrease medicare/medicaid compensation then it will still increase health care spending by increasing costs elsewhere. Also this entitlement attitude is also costing us, people who want a test run regardless if they need it or not will shop for a doctor who will give it to them.

[nurseprnRN, BSN, RN]

there is a lack of information about healthcare funding in nursing education. i have been in this stuff for donkey's years, and maybe this will give you some perspective.

hospitalization costing is like air fares. when you fly on an airplane, it is very likely that the guy in the next seat is not paying the same fare you are. insurance reimbursement for the same icd-9 (soon to be -10) diagnosis code or the same cpt (procedure) code will be different for different patients; therefore the bills those two patients' insurance companies get will be different, too. this is because the vast majority of health care in hospitals is paid by insurance, and insurance entities (like hmos, ppos, and worker's compensation) negotiate rates with the hospitals. in the case of work comp or medicaid, rates may be set by the state. for medicare, they are set by the feds. private pay rates are different (and usually astronomically higher).

so for all of these different people, their identical hospitalizations "cost" differently. of course, the costs to the hospital for these identical hospitalizations are identical...but it's their totals that control where the money goes. the hospital probably makes a small profit off the medicare case, loses some on the comp case, loses a lot on the uninsured case, and makes variable profit or breaks even on the contracted rates cases. all in all, if there is extra money at the end of paying out the expenses, that's the hospital's profit. if there isn't the hospital is in the red. you could say that means that paying customers subsidize the poor, and that would be partly true but not much of an explanation.

what was it that mr. micawber said? ""annual income twenty pounds, annual expenditure nineteen pounds nineteen and six, result happiness. annual income twenty pounds, annual expenditure twenty pounds ought and six, result misery.""

[Catch22Personified]

Hookers and Blow for the people upstairs.

Compensating for people that abuse the ER/healthcare services.

[tswim]

Just have to point this out...

#3: Advocate Health Care (IL) has 11 hospitals

#4: Northwestern Memorial Hospital (IL): has 2 hospitals

The main hospital is in one of the most expensive parts of Chicago - downtown, and they have the lowest RN pay scale among major hospitals in the Chicago area.

[Jenni811, RN]

Yea...if you think about it, i make 25/hour (starting) and i have 4 patients. That is only $6/hour per patient. yikes!