Most hospitals implemented more generous charity-care policies in the past few years -- so far with little impact on their bottom lines, according to the Center for Studying Health System Change.
Most of the about 50 hospitals interviewed in 12 nationally representative communities now offer free care and sliding-scale discounts to needy uninsured and no longer employ the most aggressive types of debt collection, such as wage garnishment.
A common threshold for free care was up to 200% of the federal poverty level, with sliding-scale discounts available to uninsured patients earning up to 400% or 500% of poverty level, the center said in an issue brief.
The changes followed class-action lawsuits in 2003 and 2004 against for-profits Tenet Healthcare Corp. and HCA and more than 400 not-for-profit hospitals and systems nationwide over their handling of the uninsured.
In half of the communities studied, at least one hospital or health system had been named in one of the class-action suits.
Starting in 2003, hospital associations urged members to establish formal policies for billing uninsured patients, a process that escalated with congressional hearings last year. Many hospitals said they adopted new policies because of their associations, principal author Andrea Staiti said.
Staiti said the interviews might have taken place too soon to evaluate the bottom-line impact of the new policies and their effect on the uninsured, since many hospitals had just made or were still making changes.
Some public hospitals limited nonemergency care to local residents or otherwise restricted access for the uninsured, and in some cases, discounts did not extend to physician services.
"We saw many hospitals shifting what was previously considered uncollectable bad debt to charity care with little or no financial impact on hospitals' bottom lines, even though hospitals generally are seeing more uninsured patients," Staiti said.
Read the issue brief.