Determinants of uncompensated care: A comparative study of a not-for-profit, an investor-owned, and a public health care institution

The Foundation's Generalist Physician Faculty Scholars Program was designed to support the career development of outstanding young faculty in academic departments/divisions of family practice, general internal medicine, and general pediatrics. This grant supports a study of the determinants of uncompensated care, a comparative study of a not-for-profit, an investor owned, and a public health care institution. This will be a case study of the determinants of uncompensated care at three large urban academic medical centers, each representing different organizational control types. While variation in access to uncompensated care according to institutional control is well documented, the policies and institutional practices accounting for those differences have not been examined. The purpose of this project is to examine, comparatively, the circumstances under which patients in three different health care environments obtain uncompensated care. Nationally, uncompensated care is estimated at 80 percent debt and 20 percent charity care. Based on preliminary investigations of medical center policies and practices toward nonpaying patients, a four-part conceptual model has been developed to explain variations in bad debt. The methodology is designed to test the conceptual model as follows. First, following a formal review of written policies at each site, interviews with relevant personnel (registration clerks, cashiers, clinicians, social workers, billing, et. al.) will elicit how policies related to prepayment, screening for medical necessity, referral, payment agreements, and collections are implemented. Second, a sample of uninsured patients at each site will be surveyed for risk factors for medical indigence, and to ascertain how they selected their site of care. At one year, payment outcome data for these patients will be analyzed. And third, the financial records of a representative sample of patients owing co-pays, deductibles, and full charges will be sorted using a spreadsheet program to ascertain the numbers of patients and charges for various categories of care, including inpatient, outpatient, primary, and subspecialty care.

Grant Details

Amount Awarded $298,027.00

Awarded on: 6/25/2001

Time frame: 7/1/2001 - 6/30/2006

Grant Number: 42208


University of Illinois at Chicago

601 South Morgan Street
Chicago, 60607-7100


Saul J. Weiner
Project Director