During 2000 and 2001, Third Sector New England investigated how hospitals develop and implement their policies on providing free care to uninsured and underinsured patients.

The research team conducted a review of the current literature concerning hospital policies on free care, and documented the actual policies of nine nonprofit hospitals in three communities in the Midwest, Southeast and Northwest.

Third Sector (formerly the Massachusetts Health Research Institute) provides education, grants and other services to nonprofit community groups.

Key Findings

Among the investigators' preliminary findings:

• All but one of the nine hospitals studied had detailed written policies on free care, with eligibility determined by income.
• Income eligibility requirements are quite low, with most hospitals offering full free care only to those at or below 150 percent of the federal poverty level.
• Typically, only hospital services are covered in free care.
• Hospitals' efforts to educate staff and community members about free-care policies are minimal at best.

Key Implications and Conclusions

• The investigators say their findings suggest that major gaps exist in the safety net that free hospital care presumably provides to uninsured and underinsured people.
• They concluded that consumer activism on this issue can make a significant difference in hospital policy, but the topic needs to rise to the policy level if consistent standards are to be established.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $98,957.