Care Financial Assistance Research Articles

Characteristics of Health Care Financial Assistance Programs Serving the Most Populous U.S. Counties.

County-based health care financial assistance programs offer improved access to health care for indigent populations by reducing or eliminating costs to receive care. We examined health care financial assistance programs serving the 10 most populous U.S. counties. We found that the percent enrollment in a county's program is strongly correlated with the percent uninsured (r=.86) and the percent undocumented (r=.83), and moderately correlated with the percent indigent (r=.43) in a county, suggesting the importance of health care financial assistance programs for these groups. Furthermore, the typical county-based health care financial assistance program covers the same income range (0-138% federal poverty level) and offers similar benefits (including coverage of emergency care and inpatient care) as Medicaid. Counseling services are frequently available to assist applicants. These characteristics allow them to serve as an alternative source of health care funding to those who are ineligible for Medicaid coverage.

Community Benefit Spending Among North Carolina's Tax-Exempt Hospitals After Performing Community Health Needs Assessments.

As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every 3 years to incentivize hospitals to provide programs responsive to the health needs of their communities. To examine the distribution and variation in community benefit spending among North Carolina's tax-exempt hospitals 2 years after completing their first IRS-mandated CHNA. Cross-sectional study using secondary analysis of published community benefit reports. Community benefit was categorized on the basis of North Carolina Hospital Association's community benefit reporting guidelines. Multiple regression analysis using generalized linear model was used to examine the variation in community benefit spending among study hospitals considering differences in hospital-level and community characteristics. Fifty-three private, nonprofit hospitals across North Carolina. Dollar expenditures as a percentage of operating expenses of the 2 categories of community benefit spending: patient care financial assistance and community health programs. Study hospitals' aggregate community benefit spending was $2.6 billion, 85% of which was in the form of patient care financial assistance, with only 0.7% of total spending allocated to community-building activities such as affordable housing, economic development, and environmental improvements. On average, the study hospitals' community benefit spending was equivalent to 14.6% of operating expenses. Hospitals with 300 or more beds provided significantly higher investments in community health programs as a percentage of their operating expenses than hospitals with 101 to 299 beds (P = .03) or hospitals with 100 or fewer beds (P = .04). Access to care was not associated with patient care financial assistance (P = .81) or community health programs expenditures (P = .94). The study hospitals direct most of their community benefit expenditures to patient care financial assistance (individual welfare) rather than population health improvement initiatives, with virtually no investments in community-building activities that address socioeconomic determinants of health.

Did Performing Community Health Needs Assessments Increase Community Health Program Spending by North Carolina's Tax-Exempt Hospitals?

As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every 3 years. This study assessed whether the IRS CHNA mandate incentivized North Carolina's tax-exempt hospitals to increase investments in community health programs. The authors gathered the 2012-2016 community benefit reports of 53 North Carolina private, nonprofit hospitals from the North Carolina Hospital Association. Community benefit spending data from the year of the first CHNA were compared to that 2 years later using paired t tests among matched subjects. No significant increases were found in hospitals' community health programs spending (P = 0.6920) or in providing patient care financial assistance (charity or discounted care) (P = 0.0934). In fact, aggregate community health programs spending effectively decreased by 4%, from $393.3 million to $377.5 million. Among all community benefit items, only the unreimbursed cost for treating Medicare patients increased significantly (P = 0.0297). The proportion of spending on community health programs relative to patient care financial assistance decreased significantly (P = 0.0338). Performing CHNAs did not incentivize North Carolina's tax-exempt hospitals to progressively invest in community health programs. The hospitals continue to spend heavily on patient care financial assistance and little on disease prevention and community health improvement activities. These findings suggest that tax-exempt hospitals continue to function as a safety net for the poor and the uninsured rather than as active partners in population health management initiatives. At present, performing CHNAs may be more a demonstration of compliance than a tool to improve population health.

Incentives at the Eligibility Threshold: An Examination of Child Care Financial Assistance Policies

For families with children, employment comes at a price. They must subtract from their wages the cost of someone else caring for their child. Their wage minus the costs of obtaining child care, transportation, and other expenses that may be generated by employment is generally referred to as the effective wage. The Child Care Development Fund (CCDF) child care subsidy voucher, the Earned Income Tax Credit (EITC), and the Child and Dependent Care Credit (CDCC) are all intended to increase the effective wage of parents to support them entering and staying in the workforce. This paper explores the trade-offs between employment and effective wage that parents must make through the lens of three hypothetical North Carolina families facing promotion, bonus, and employer relocation opportunities. Through their eyes we understand why it would be rational to turn down these opportunities due to the potential loss of thousands of dollars in benefits. These situations demonstrate the weaknesses of the current system, where the needs of employers and employees become increasingly opposed as families approach the income eligibility threshold and the portability threshold. This paper proposes a policy to better align the needs of employers and employees by restructuring the incentive system to phase out benefits gradually, guarantee help to anyone who is eligible, make support sensitive to regional changes in child care prices, and administer it through the tax system rather than local social services offices throughout the country. While this paper focuses on the child care benefit system, the framework used to explore the issues of reversed incentives at the eligibility threshold can be applied to any social policy with income eligibility requirements.