Practice pressures diminish charity care

Provision of free care is most common in small or solo practices, but fewer physicians are working in those practices, a survey reports.

By Damon Adams, AMNews staff. April 17, 2006.

If you're feeling like you have less time or income to provide charity care to patients, you're not alone.

About three in four doctors provided free care to patients at offices, hospitals and clinics in 1996-97. But that number dipped to two in three doctors in 2004-05, according to a national study by the Center for Studying Health System Change, a nonpartisan policy research organization based in Washington, D.C.

The decline means a shrinking safety net for a rising number of uninsured, which climbed from 39.6 million Americans in 2000 to 45.5 million in 2004.

Physician leaders said the study's findings are a wake-up call that something needs to be done to provide insurance to those without it. They also said the study correctly highlights how increasing time demands and financial burdens make it more difficult for physicians to provide free care.

"Charity care is not the solution to the problem of the uninsured in this country," said American Medical Association President J. Edward Hill, MD. "We've got to address the uninsured problem to stop the escalation of people going on the uninsured rolls."

Researchers examined data from surveys of 12,000 physicians in 1996-97, 1998-99 and 2000-01 and of 6,600 physicians in 2004-05. They found that 68% of doctors provided free or reduced-cost care in 2004-05, down from 76% of physicians in 1996-97. Despite the percentage point drop, the actual number of physicians providing charity care remained stable, because the pool of practicing physicians expanded. But the number of charity care hours per 100 uninsured patients declined from 7.7 hours in 1996-97 to 6.3 hours in 2004-05, an 18% decrease.