Hospitals, clinics, and care organizations

Organizations deliver care and manage the revenue, staffing, and facilities needed to provide it.

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Problems that hurt them

Paths that fix these help them.

U.S. territories get capped, lower federal health funding: Territory providers are paid less than mainland peers.
Drug shortages of cheap, essential generics: Dependence on few factories leaves hospitals exposed to essential drug shortages.
Mental health care is hard to get: Emergency departments board psychiatric patients who cannot access other care.
Cyberattacks can halt payments and care: Cyberattacks disrupt claims and leave providers unpaid.
Copays keep billing systems alive and still deter poorer patients: Copays require collection, exemptions, and billing work.
Staffing mandates raise costs and may close facilities: Hiring shortages and staffing mandates may force beds or facilities to close.

Problems they gain from

Paths that fix these cost them.

Medical debt affects about 100 million people: Hospitals sell medical debt or sue to collect it.
Facility fees: the same service costs more in a hospital-owned building: Hospital systems collect facility fees on top of physician fees.
Rural hospital closures: Urban systems sometimes gain patients from rural hospital closures.
Nursing and direct-care shortages and burnout: Operators benefit from keeping staffing thin.
Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
Racial, income, and geographic disparities: They can select better-paying patients over those with lower-paying coverage.
Low-value care and overtreatment: Per-service payments reward additional low-value care.
Overdose crisis and gaps in addiction treatment: Unregulated treatment operators benefit from the treatment system’s gaps.
Long-term care requires spending down to poverty: Institutional coverage bias benefits nursing-home operators.
Nursing home understaffing and quality: Owners benefit from related-party transactions and real-estate structures.
Hospice growth, for-profit entry, and fraud: Hospices benefit from long-stay patients.
Prevention and public health are underfunded: More chronic disease creates more treatment business.
Records don't follow patients: Fragmented records help keep patients within their systems.
Paying a fixed amount per patient rewards doing less: They keep the difference when care costs less than fixed payments.
Covering long-term care can pull unpaid family care into the paid system: Home-care agencies gain paid care work previously done by families.
Targets and quality metrics invite gaming: They can benefit by changing referral dates, avoiding sick patients, or upcoding.