insurance plans) have consistently paid more than government payors (Medicare / Medicaid) and have, in effect, subsidized government reimbursement. Healthcare Service Payment to Cost Ratio, 1990 - 2006 0, 140% — Private Payor — ~~ Medicare — Medicaid 120% 110% 100% 90% Payment to Cost Ratio 80% 70% 60% | T T T T T