ts, and toward attending phy-sicians.
The growth of employer-provided health care insurance, employer-assisted health care insurance, private health care insurance, and government-funded health care services, coupled with the rapidly rising costs of health care services, has, however, resulted in significant changes with respect to deci-sion prerogatives relative to the selection of health care ser-vices delivery institutions (Mackenzie, 1984). When patients were primarily responsible for funding their own health care services, they and their private physicians were able to select the specific hospital when such an institution was required. Even as growth in the use of health care insurance occurred,
3this decision pattern did not change appreciably, until the dramatic escalation in the cost of institutional-delivered health care services began (Mackenzie, 1985). The combination of escalating costs and the shift in funding responsibility, however, prompted changes in the hospital selection decision pattern.
One of the problems in funding the cost of health care services was cost shifting. Cost shifting is an action on the part of a health care provider whereby the costs (or a portion of them) for delivered health care services are shifted from the recipient to others receiving health care services from the same provider (Friedman, 1982). The practice of cost shifting in the health care industry is as old as is the practice of physicians providing care to the needy at little or no cost, while exacting substantial fees for service from those persons better able to pay. On the other hand, the practice of cost shifting is as new as is the practice of hospitals in the United States of charging higher fees for service for delivered care being funded by private insurance than those fees charged for delivered care being funded by the federal government (Friedman, 1982). This newest manifestation of cost shif...