University of North Carolina at Chapel Hill, USA.
Med Care Res Rev. 2024 Apr;81(2):164-170. doi: 10.1177/10775587231211366. Epub 2023 Nov 18.
High levels of uncompensated care impact hospital profitability and may create challenges for rural hospitals at financial risk of closure. We explore 2019 hospital uncompensated care as a percentage of operating expenses and draw comparisons at a state level by Medicaid expansion status and rural classification. We further compare uncompensated care in 2019 to 2014 in rural hospitals by Medicaid expansion implementation timing. We found that, overall, rural hospitals had more uncompensated care than urban hospitals in 2019 (3.81% vs. 3.12%), but there was a larger difference by expansion status (expansion states: 2.55% vs. non-expansion states: 6.28%). In all but seven states, rural hospitals reported higher uncompensated care than urban, and the 14 states with the highest uncompensated care had not expanded Medicaid. We observed that rural hospital uncompensated care in non-expansion states increased between 2014 and 2019, while the most dramatic decrease occurred in late-expansion states.
高比例的无偿医疗服务会影响医院的盈利能力，可能会给面临关闭风险的农村医院带来挑战。我们探讨了 2019 年医院无偿医疗服务占运营费用的比例，并按医疗补助计划扩面情况和农村分类在州一级进行了比较。我们还比较了 2019 年和 2014 年农村医院在实施医疗补助计划时间方面的无偿医疗服务情况。我们发现，总体而言，2019 年农村医院的无偿医疗服务比例高于城市医院（3.81%对 3.12%），但扩面情况的差异更大（扩面州：2.55%；非扩面州：6.28%）。在除了七个州之外的所有州，农村医院的无偿医疗服务比例都高于城市医院，而无偿医疗服务比例最高的 14 个州没有扩大医疗补助计划。我们观察到，非扩面州农村医院的无偿医疗服务在 2014 年至 2019 年间有所增加，而在扩面较晚的州，这一比例下降幅度最大。
