Why are health care institutions dissatisfied with reimbursement based on Medicaid's or Medicare's values-based purchasing programs?
• Because clients are well informed and know they do not really have to pay their hospital bills.
• Because insurance companies and other third-party payers copy Medicaid's approach to holding down costs.
• Because it is harder to continue giving charity care when less reimbursement is received from the federal government.
• Because recent legislation has required that all reimbursement be based on quality performance measures.