Do Public Health Systems Offset Hospital Uncompensated Care Costs? Evidence from a Longitudinal Community Cohort



Objective: The provision of community benefits in exchange for tax-exemption status for Not-for-Profit (NFP) Hospitals has been a health policy area of interest especially as it relates to the adequacy of benefits provided relative to the amount of foregone governmental tax revenue. This issue is even more salient with ACA in place. In this study, we examine the factors that affect the level of hospital community benefit levels as measured by hospital uncompensated care costs.

Methods: We used a unique longitudinal dataset that combined the 2006, 2012, and 2014 waves of the National Longitudinal Survey of Public Health Systems with data from the Centers for Medicare & Medicaid Services Hospital Cost Reports. Panel regression methods were used to estimate the determinants of hospital uncompensated care costs. Explanatory variables of interest include hospital participation in local public health systems and whether the hospital was located in a jurisdiction characterized as having a comprehensive public health system.

Population Studied: Non-for-profit hospitals and local governmental health agencies in the U.S.

Results: Between 2012 and 2014, average uncompensated care costs for NFP hospitals in our sample declined 7 percent (n=1293). Fixed effects regression results suggest uncompensated care costs were 0.12 percent lower for NFP hospitals located in comprehensive public system jurisdictions (p<0.05) but were positively related to the level of hospital participation in local health systems.

Conclusion: This study provides evidence of the effect that community socioeconomic characteristics and public health system capital have on hospital uncompensated care costs.


Project: The Effect of Uncompensated Care Costs on Hospital Contributions to Population Health Improvement Activities
Resource: Event Details
Authors: Mamaril CB, Parks A, Timsina L, Hogg Graham RA, Mays GP