Although the advance of technology has made expensive medical procedures available to the wealthy, such procedures are out of the reach of low-income patients.

If hospitals do not find ways of raising additional income for unreimbursed care, they must either deny some of that care or suffer losses if they give it.

Some patients have incomes too high for eligibility for governmental health insurance but are unable to afford private insurance for hospital care.

If the hospitals reduce their costs in providing care, insurance companies will maintain the current level of reimbursement, thereby providing more funds for unreimbursed care.

Even though philanthropic donations have traditionally provided some support for the hospitals, such donations are at present declining.