And payers would benefit from change to increase the incentives for efficiency. All have known problems. Even with the expansions in coverage, the District is contemplating, at least 60K will remain uncovered. Moreover, DSH funds are scheduled to decline. Finally, paying DSH or subsidies in big lumps doesn't give hospitals incentives either to take an additional patient or to be efficient in patterns of care.
Uncompensated care is already down overall, as noted above.
It's a tempting target for reduction in that it does not require expensive new systems. And the more focus of hospital attention shifts to the market, the less attention there can be for non-paying patients. It's simple logic that markets act to serve those with money to spend. For DC, the crunch is likely to come via DC General and its parent PBC which are legally obligated to serve. Two final points about the implications for the District government.