title: The cost-shift payment 'hydraulic': foundation, history, and implications.
abstract: The cost-shift payment "hydraulic" is an integral component of the fragmented U.S. health care financing system. If private payers' acceptance of the cost-shifting burden were to erode, our system of health care financing could become unstable. This is especially true for the hospital industry. In this paper we provide a series of examples of cost shifting and a historical profile of the cost shift in the hospital industry since 1980, noting that cost-shifting pressures seem to fluctuate over time and across health care markets. Cost shifting need not be dollar per dollar, as hospitals can absorb some degree of cost-shifting pressure through increased efficiency and decreases in service provision.
authors.affiliation: Lewin Group, Falls Church, VA, USA. al.dobson@lewin.com
authors.forename: Allen
authors.initials: A
authors.lastname: Dobson
authors.forename: Joan
authors.initials: J
authors.lastname: Davanzo
authors.forename: Namrata
authors.initials: N
authors.lastname: Sen
mesh_terms: D003361:Cost Allocation / Q000266:history*; D004469:Economics, Hospital; D049673:History, 20th Century; D017721:Hospital Costs / Q000458:organization & administration*; D017149:Private Sector / Q000191:economics; D014481:United States