FORTUNE -- American health care is screwed up. It is a bizarre market where the prices that patients pay do not match the quality of care. Unfortunately, that's old news. What is new is the nitty-gritty -- details about why hospitals might not have any financial incentive to follow best practices. A new paper from researchers affiliated with Harvard, Boston Consulting Group, and nonprofit health care delivery system Texas Health Resources suggests that, in some cases, providing worse care pays off for hospitals. On a hopeful note, some companies are stepping in to challenge the system.