在我看来，你忽略了导致成本如此之高的根本原因。 问题最初来自 保险体系本身。以下这些成本，本不应该由医疗服务提供者承担，却被强行转嫁给了他们： 1 患者自付额（deductible）的信用风险 2 预授权（Pre-Auth）被拒或延迟时的资金占用成本（float） 3 医生/行政人员为申诉预授权的时间与费用保险公司对合同价的少付、拖欠 4 每年都会变化的理赔流程所带来的行政成本 5 为上述问题而支付的咨询服务费用 6（不包括那些超级强势、能改变规则的医疗网络） 面对这些被强加的成本压力，医院的反应是： 1 发明“设施费”（Facility Fees） 2 对可议价患者收取过高费用 3 滥用 340B 项目 4 利用“场地中立性”（site neutrality）规则套利 5 压低医生与护士的薪酬 关键的问题是： 如果医院不用面对以上保险公司的这些问题，它们是否能以医院自身的收费结构（而不是独立执业医生的费用）实现盈利？ 我认为答案是肯定的。 已经有不少医院在 Medicare 和 Medicaid 的收费标准下实现盈利——关键是它们必须让自身的成本与预期收入保持一致。 很想听听大家对此的看法。 IMHO , you are missing what made the costs so high. It starts with the insurance plan. These are the costs providers take risk on and shouldn’t : 1. The credit risk of the deductible 2. The float for Pre Auth denials/delays 3. The doctor/admin cost to appeal PA 4. The underpayments by carriers of contracted rates. 5. The admin costs of processing, that changes ever year. 6. All the consultants they pay re the above 7. (Excluding networks that are so dominant they see the rules ) In response the hospitals try to compensate for the above by : 1. Inventing Facilities Fees 2. Overcharging patients they will negotiate 3. 340b abuses 4. Site neutrality arbitrages 5. Underpaying doctors and nurses The question is what would happen for hospitals that didn’t have the above issues with carriers ? Could they be profitable at hospital (as opposed to Indy physician rates ) I think the answer is yes. Multiple hospitals make money on Medicare and Medicaid rates. But they make sure their expenses fall in line with expected revenue. Curious what everyone here thinks