The historic payment system for reimbursing hospitals both by insurers and by Medicare has been Retrospective Cost Based Reimbursement(RCBR). This system of reimbursement encourages hospitals to over charge in order to cover the costs of the uninsured who utilize the hospital. Charges have continued to rise year after year eventually putting the employers at a point where they could no longer afford the payments. For physician reimbursements, both insurers and Medicare employed the Usual and Customary(U+C) approach to reimbursement. This practice, which averaged the charges for a procedure in a region, also encourages doctors to over-charge in order to raise the average amount paid to them for a procedure. These two systems, RCBR and U+C eventually started to suck too much money out of the insurers, employers, and the Medicare/Social Security trust fund so that interventions were deemed necessary. Perhaps the biggest intervention adopted by the private sector to reduce medical service costs was the trend toward businesses self-insuring. By doing so, they avoid......

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