Solving uncompensated hospital care: targeting the indigent and the uninsured.

Abstract

Prologue: Uncompensated hospital care is a growing problem facing federal and state legislators, hospitals and doctors, and, indeed, all of society. The American Hospital Associations Annual Survey of Hospitals estimated that $6.2 billion of uncompensated care was provided by community hospitals in 1982. When uncompensated care costs are compared to either total hospital costs or total charges, this figure represents a relatively small proportion of the total —some 6 percent of community hospital payments. However, the uncompensated care burden is not equally distributed among hospitals. Some institutions, particularly publicly sponsored ones, are being forced to bear an increasingly larger share of the burden. In this paper, Gail Wilensky sets out the dimensions of the problem and possible policy options for dealing with it. Wilensky underscores, as the Reagan administration has not, that market-oriented medical care reforms cannot succeed without more explicit policy treatment of the uncompensated care issue. Wilensky is director of Project HOPE's Center for Health Affairs and vice-president of its domestic division. A nationally recognized health services researcher and policy analyst, Wilensky holds a Ph.D. in economics from the University of Michigan. She was instrumental in the design and management of the National Medical Care Expenditures Survey while she worked (1975-1983) at the National Center for Health Services Research.