Hospital and Community Attributes Associated With Charity Care Policy Generosity
Nicholas Wong, Samantha Randall, Erin Trish, Erin DuffyABSTRACT
Objective
To evaluate hospital and community characteristics associated with attributes of charity care policies. Charity care is a highly utilized avenue for medical debt relief. Hospitals are allowed some discretion when setting charity care policies, yielding heterogeneity in charity care generosity and availability to patients.
Study Setting and Design
We conducted a cross‐sectional study using data on charity care policies from US hospitals collected through hospital websites and direct email and phone contact between September 2023 and April 2025 by the Lown Institute.
Data Sources and Analytic Sample
We reviewed 2418 hospitals from 50 US states, including non‐profit, for‐profit, and government‐owned hospitals. The primary outcomes were the likelihood that certain hospital characteristics were associated with offering fully or partially discounted care and income limits for patient eligibility. Additional outcomes include eligibility for the underinsured, patients with large bills, residency requirements, and use of presumptive eligibility screening.
Principal Findings
System affiliation was positively associated with offering fully discounted (Est, 90.5%; 95% CI, 88.9%–92.0% compared with Est, 78.9%; 95% CI, 76.4%–81.5% for non‐affiliated hospitals) and partially discounted care (Est, 85.5%; 95% CI, 83.5%–87.2% compared with Est, 77.1%; 95% CI, 74.2%–80.0% for non‐affiliated hospitals), and was associated with a significant percentage‐point increase in charity care income thresholds (32.69, 95% CI, 25.20–40.17; for fully discounted care). Non‐profit hospitals reported the highest likelihood of offering both fully (Est, 96.7%; 95% CI, 95.8%–97.7%) and partially discounted care (Est, 85.5%; 95% CI, 83.5%–87.2%), and were significantly more likely to use presumptive eligibility screening (Est, 82.7%; 95% CI, 80.8%–84.6%) compared with for‐profit hospitals.
Conclusions
Overall, tax‐exemption status, system affiliation, and community socio‐economic and legislative factors were associated with more expansive and generous charity care policies. Policymakers can consider hospital incentives and capabilities when designing policies to address medical debt.