Center for Studying Health System Change

U.S. Physician Charity Care Continues Decade-Long Decline

2 out of 3 Doctors Provide Charity Care in 2004-05—Down from 3 out of 4 in 1996-97

News Release
March 23, 2006

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—The proportion of U.S. physicians providing charity care dropped 8 percentage points in the last decade, falling to 68 percent of physicians in 2004-05 from 76 percent in 1996-97, according to a national study released today by the Center for Studying Health System Change (HSC).

The drop in physician charity care occurred as the number of uninsured Americans grew to 45.5 million in 2004, signaling growing stress on the health care safety net.

"The decline in physician charity care—long a critical part of the safety net—is alarming given the increase in the number of uninsured Americans," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

The percentage of physicians providing any free or reduced cost care decreased to 68.2 percent in 2004-05 from 71.5 percent in 2000-01, continuing a trend that dates to at least 1996-97, when 76.3 percent of physicians provided charity care, the study found. Despite a decrease in the proportion of physicians providing charity care, the number of physicians offering charity care has remained relatively stable because the overall number of U.S. practicing physicians increased from about 347,000 in 1996-97 to 397,000 in 2004-05.

But the amount of physician charity care relative to the number of uninsured has dropped, with the number of charity care hours per 100 uninsured people falling from 7.7 hours in 1996-97 to 6.3 in 2004-05—an 18 percent decline. Most of this decrease has occurred since 2000-01, primarily because of the large increases in the uninsured, from 39.6 million in 2000 to 45.5 million in 2004.

"Already, there are signs that uninsured Americans are having more problems getting care, and if the decline in physician charity care continues, those problems are probably going to get worse," said HSC Senior Researcher Peter J. Cunningham, Ph.D., coauthor of the study with HSC Health Research Analyst Jessica H. May.

The study concludes that ongoing financial pressures and changes in physician practice arrangements may in part account for the continuing decline in physician charity care.

Based on HSC’s nationally representative Community Tracking Study Physician Survey, the study’s findings are detailed in a new HSC Tracking Report—A Growing Hole in the Safety Net: Physician Charity Care Declines Again—is available here. The 1996-97 and 2000-01 surveys contain information on about 12,000 physicians, and the 2004-05 survey includes responses from more than 6,600 physicians. Response rates for the surveys range from 52 percent to 65 percent.

Other key study findings include:

• Physician Specialty - The proportion of physicians providing charity care declined across all major specialty groups, geographic regions and in both urban and rural areas. Surgical specialists are the most likely among specialty physicians to provide charity care, probably because many are required to be on call at hospitals and encounter many uninsured patients who need emergency services. Pediatricians are the least likely to provide charity care, perhaps reflecting the fact that fewer children are uninsured because of more generous public coverage eligibility.
• Practice Characteristics - Levels of charity care are highest among physicians in solo or small group practices and those that are full or part owners of their own practice. About 80 percent of physicians in solo practice or small groups-10 physicians or fewer-provided charity care in 2004-05, and this has not changed significantly since 1996-97. By comparison, physicians in larger groups and institutional-based practices (i.e. medical schools or hospitals) are much less likely to provide charity care, and charity care among these physicians declined sharply between 1996-97 and 2004-05. During the same period, the percentage of physicians in solo or two-physician practices declined from 40 percent to 31 percent, while the percentage in large groups, hospitals, and medical schools increased from 21 percent to 26 percent.
• Physician Income - Provision of charity care has declined for physicians at all levels of income. Physicians at the highest income levels continue to report the greatest provision of charity care, with 75.6 percent of physicians with practice incomes greater than $250,000 providing charity care in 2004-05, compared with 66.4 percent of physicians earning less than $120,000.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.