* Background - Hospital uncompensated care (UC) plays a vital role in access for the uninsured and underserved. Defining "uncompensated" has been controversial. This research expands the traditional definition to include all sources of UC (charity care, bad debt and public payer shortfalls) and subtracts all subsidies, notably Medicaid DSH funds.
* Policy questions - This redefinition raises several policy questions - 1) Does the distribution and "burden" of uncompensated care change? 2)Are there significant differences in provision between public, non-profit and for-profit hospitals?
* Data and methods - Using California hosptial financial data from 1994 - 1998, cross-sectional trends across years and by hospital type are examined. Multivariate linear regression modeling to estimate differences between hospital types while controlling for confounding factors.
* Findings - Under the expanded definition, the total dollar amount of UC provided in California is twice as high as calculated under the traditional definition. The dollar amount provided by the average hospital also doubles. The change of definition increases the share of all UC provided by public hospitals. The share provided by non-profit hospitals decreases. Public hospitals and teaching non-profits experience an increase in the "financial burden" of UC under the expanded definition.
* Policy implications - Public and teaching hospitals traditionally carry a disproportionate burden of caring for the uninsured. Under an expanded definition of UC in California, their respective financial burdens are greater than previously reported. Medicaid DSH funds and other subsidies may not be sufficient to alleviate these financial burdens.
Learning Objectives: 1. Provide overview of hospital uncompensated care in California 1994 - 1998 2. Articulate expanded definition of uncompensated 3. Discuss policy implications of distribution of uncompensated care burden for access to care, non-profit community benefits and public hospitals.
Keywords: Access to Health Care, Hospitals
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.