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Insurers vs. Hospitals: Who Has the Upper Hand?

Jeff Elliott for HealthLeaders Media, December 8, 2010

Insurers, I suspect, will leverage studies like this one from HSC to make a case for regulation-driven fairness amid new healthcare delivery models being bantered about such as the accountable care organization (ACO). Insurers have been vocal about their fear of collusion among ACO hospitals that will drive rates up.

But considering that the report comes amid some impressive financial results from insurers during the third quarter, I'm led to believe that even though they may take it on the chin in certain regions, they're weathering this anomaly quite well.

I'm sure there's validity in the report that some hospitals are sticking it to insurers, which is probably not unlike when I drive through a relatively poor neighborhood and find gas costs a good 30 or 40 cents more than in my middle-class suburb. The thought behind pricing like this, I suspect, is "what other option do you have?"

With the noted exceptions, I'm apt to believe that most healthcare organizations are struggling under record high bad-debt levels and lower Medicare reimbursements, which keeps me from feeling too sorry for insurers. But reform could always change that …

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