My friend is the administrator of a small hospital (~15 beds).

He says with insurance one of the problems is that the insurance company will sometimes pay out less than the cost of the service, and there's nothing they (the hospital) can do about it.

He says they actually have a slightly better rate of payment for services for non-insured patients.

Also he said there's a serious problem with people not paying their share of the bill, when the deductible has not yet been met.