Fees need to be seen in wider context of array of costs

The article Hospital charges bring a backlash” (Page A1, March 11) does not provide adequate background or context for the charges. Hospital facility fees need to be understood in the wider context of the health care delivery and payment systems.

Hospitals serve their communities through their main facilities, but also by supporting physicians and an array of medical and societal services that are not directly reimbursed by Medicare, Medicaid, or private insurers. These real but unrecognized hospital costs include providing 24-seven emergency care, disaster preparedness, backup services for other providers, medical education and research, and the full cost of caring for the uninsured and underinsured.

The staff and equipment required for hospital-level care are extremely sophisticated and expensive, and the critical needs of behavioral health and substance abuse patients are still inadequately covered by both government and private insurers. Lately hospitals have also been providing increased support to local physicians who would otherwise be forced out of practice in their communities in the face of mounting expenses for technology, staff, and regulatory requirements.


These costs are spread across hospital services, including outpatient care, to ensure that vital services are maintained. Despite these artifacts from a fee-for-service health care payment system, hospitals are still working to reduce the cost of care in all settings. Realizing the enormous challenges hospitals face while trying to support their communities and physicians helps make facility fees more understandable. A rapidly integrating health care delivery system along with government paying its fair share for the cost of care will help minimize disparities in fees among various care settings.

Lynn Nicholas

President and CEO

Massachusetts Hospital