The boundaries of generosity : can administrators in charity hospitals provide "free care"?
By: DRUCKER, Mark L
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ArticlePublisher: New York : Marcel Dekker, 1997International Journal of Public Administration - IJPA 20, 6, p. 1221-1253Abstract: The medical marketplace changes of the 1980's and 1990's have helped to redefine the charity role which charity hospitals have played. How might charity hospital administrators succeed in fulfilling this responsability, while simultaneously protecting the financial well-being of their institutions? This paper discusses how increases in charity care volume may relate to declining opportunities for cost-shifting, increased pressures for revenue-raising utilization policies, and limited support from government to subsidize uncompensated care. "Charity" and "free care" concepts are discused, and economic and historial perspectives are introduced to provide the context for studying this issue.Abstract: The 1980's experience for charity hospitals in Massachusetts provides examples of specific policies within a state in which uncompensated care played a pivotal role in the debate over universal coverage. But there has been a quite recent refocussing upon the nonprofit hospitals' tax exemption. If such political pressures in the 1990s require a review of community benefits standards at charity hospitals, then perhaps the resolution of access questions for the poor and uninsured within forthcoming national health care reforms properly will take into account considerations of quality of care.
The medical marketplace changes of the 1980's and 1990's have helped to redefine the charity role which charity hospitals have played. How might charity hospital administrators succeed in fulfilling this responsability, while simultaneously protecting the financial well-being of their institutions? This paper discusses how increases in charity care volume may relate to declining opportunities for cost-shifting, increased pressures for revenue-raising utilization policies, and limited support from government to subsidize uncompensated care. "Charity" and "free care" concepts are discused, and economic and historial perspectives are introduced to provide the context for studying this issue.
The 1980's experience for charity hospitals in Massachusetts provides examples of specific policies within a state in which uncompensated care played a pivotal role in the debate over universal coverage. But there has been a quite recent refocussing upon the nonprofit hospitals' tax exemption. If such political pressures in the 1990s require a review of community benefits standards at charity hospitals, then perhaps the resolution of access questions for the poor and uninsured within forthcoming national health care reforms properly will take into account considerations of quality of care.
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