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Juggling multiple payers: American problems and foreign solutions.

The number and diverse methods of payers are among the principal causes of disarray in American hospital finance. Hospital managers are preoccupied with an intricate and deceptive shifting of costs among payers to maximize their revenues. In all other developed countries third parties cooperate, either voluntarily or by regulation, rather than try to shift costs to each other. In some countries third parties merge and hospital budgets are spread across all payers by standard calculations. In some countries with multiple payers, a common financial office administers all transactions with hospitals. The trend is to concentrate payment in a single source. Hospitals abroad are more stable than those in the United States. With stability, however, come inhibitions against risk, innovation, and failure.