Difficult to say if that's the case for hospitals, since they run on public money anyway, so they could run at a deficit and it would hide the higher cost than

Difficult to say if that's the case for hospitals, since they run on public money anyway, so they could run at a deficit and it would hide the higher cost than what they charge. But in all cases, social security pays exactly what you are billed. In most cases you pay yourself the hospital, clinic, doctor, whatever, and social security then gives you part of the costs (depending on the procedure) and if you have one, your private health insurance gives you the rest (or less, depending on your plan, of course). The tendency is at removing the unnecessary payment by the patient before being reimbursed, but for now this at least serves as a way to ensure you know exactly how much was paid for the procedure, and to prevent too many excesses (since, well, the patient has to be able to pay, even if he gets reimbursed).