Medical Charity Care Losing Ground in U.S.

Americans are getting less charity care from doctors. The number of physicians providing charity care has remained relatively stable. But the number of uninsured people has gone up over the past decade.

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Doctors are providing less free care to patients at a time when the need continues to grow. Federal health officials now say as many 45 million Americans do not have health insurance.

NPR's Patricia Neighmond reports on the survey from the Centers for the Study of Health System Change, which monitors care for the uninsured.

PATRICIA NEIGHMOND reporting: Over the past decade, researcher Peter Cunningham says charity care provided by doctors has decreased by about 12 percent.

Dr. PETER CUNNINGHAM (Senior Health Researcher, Centers for Studying of Health System Change): So it's gone from about three out of four physicians providing some charity care in the mid-90s, to about two out of three physicians today.

NEIGHMOND: An alarming decrease, says Cunningham, because the number of uninsured continues to rise. The survey found less charity care among all specialties: primary care, surgery and sub specialties; and in all areas, urban as well as rural. Cunningham says it use to be different.

Dr. CUNNINGHAM: There's a long tradition in the U.S. healthcare system of physicians providing charity care, either to uninsured persons or other medically indigent individuals. They've either done it in their own practice or as volunteers at free clinics. This has, in a way, provided a sort of cushion for those who are uninsured.

NEIGHMOND: And it was mostly doctors in solo or small practices that delivered the bulk of free care. That's still the case. But today, many doctors find it difficult to remain in small practices. Many are leaving for larger group practices and institutions, like hospital and medical schools, which are able to negotiate better payments with health plans. Other sign up with HMOs as employees; and Cunningham says these groups provide less charity care.

Dr. CUNNINGHAM: There's fewer docs that are actually owning their own practice, more are employees of larger practices, like larger groups. And what this does is that when, when you're not an owner of your own practice, it gives you less control over the types of patients they see. And we think that's one reason why these physicians, that is, those who don't own their own practice, are less likely to provide charity care.

NEIGHMOND: And if fewer doctors provide free care, patients must rely even more on other alternatives, like community health centers, free clinics and public hospital; many of which are also struggling under a hard-pressed healthcare system.

Dr. Richard Neubauer is an internist in anchorage, Alaska, with the American College of Physicians. In a well functioning system, he says, internists would be the frontline of access to medical care. But for these physicians in particular, Neubauer says, that's become even more financially difficult.

Dr. RICHARD NEUBAUER (American College of Physicians): The gap between payment for technical procedures and what's kind of generally lumped together as cognitive care, the gap has widened over the years. That's well documented, and that's resulting in far fewer people being willing to do charity care. I think it's actually a combination of things. I think it's partly that they're less willing because they're less able to.

NEIGHMOND: The survey found doctors with the highest incomes do provide the most charity care. It also says that over all, physician income has declined in recent years for primary care and specialists.

Patricia Neighmond, NPR News.

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