Percentage of Physicians Offering Charity Care Decreasing

The percentage of physicians who provide charity care to uninsured patients is decreasing, while the number of uninsured is increasing, according to a study released by the Center for Studying Health System Change on Thursday, the Wall Street Journal reports (Brown, Wall Street Journal, 3/23).

For the study, researchers surveyed 6,600 doctors, finding that 68% reported delivering some no-cost or discounted care to low-income patients in 2004-2005, compared with 76% of doctors in 1996. In addition, researchers reported that the number of uninsured U.S. residents increased from 40 million in 2000 to 45.5 million in 2004 (Connolly, Washington Post, 3/23).

While the percentage of doctors providing charity care decreased in all specialties, surgeons reported the highest rate of charity care among all specialties, with 78.8% providing no-cost or discounted care. Surgeons might provide the most charity care because many work in emergency rooms, which often treat the uninsured.

According to the study, about 60% of pediatricians provided charity care -- the lowest rate among the specialties. According to the AP/Houston Chronicle, the rate could be because children are more likely to have insurance than adults.

The study also finds that doctors in solo or smaller practices were more likely to provide charity care. About 81% of doctors in solo or two-person practices provide some charity care, compared with 66% of doctors in practices with 11 to 50 physicians and 62% of doctors in practices with more than 50 physicians, the AP/Chronicle reports (Freking, AP/Houston Chronicle, 3/23).

In addition, the percentage of doctors in practices with 10 or fewer physicians providing charity care has not changed significantly since 1996, according to the study. According to the study, the number of physicians providing charity care has remained stable, though the overall number of practicing physicians has increased 14% since 1996.

The study concluded that uninsured patients will have to rely on formal safety net providers such as free clinics, public health centers or public hospitals, while policy measures are needed to lower the number of uninsured U.S. residents (Wall Street Journal, 3/23).

Peter Cunningham, senior researcher for HSC, attributed the decrease in charity care to stagnant reimbursement rates from the government and lower fees negotiated by insurers. He said, "In the past, a lot of physicians were able to afford it because they could charge paying patients higher rates."

In addition, Cunningham said an increase in the number of physicians leaving solo practices for large group practices could have caused the drop in charity care. He added, "This means they have less control over the types of patients they see" (AP/Houston Chronicle, 3/23).

Cunningham said more people will have to be insured or higher taxes will have to pay for more free clinics, public hospitals and funding for Medicaid, adding, "Traditionally the private system delivered a good amount of private charity, but it is becoming increasingly more difficult. That means the uninsured will have to find help from a more public safety net" (Yi, Los Angeles Times, 3/23).

J. Edward Hill, president of the American Medical Association, said, "Time pressures for physicians have increased enormously, and there have been income drops" (Washington Post, 3/23). He added, "Charity care is not the solution to our health coverage problems in this country. Maybe this will help wake up everybody so they understand we've got to solve the problem of almost 46 million people without (insurance) coverage" (AP/Houston Chronicle, 3/23).

The study is available online.

NPR's "Morning Edition" on Thursday reported on the survey. The segment includes comments from Cunningham and Richard Neubauer, a physician in Alaska associated with the American College of Physicians (Neighmond, "Morning Edition," NPR, 3/23).

The complete segment is available online in RealPlayer.