title: Doing away with uncompensated care of the uninsured.
abstract: As more people lose their health insurance, an increasing volume of uncompensated care is absorbing billions of dollars of limited resources of the nation's hospitals, health systems, and other provider organizations. As yet, no provider organization has developed a comprehensive management approach to address this growing problem. Currently, the money spent on uncompensated care is viewed as a drain on institutional bottom lines rather than as a fund dedicated to improving the health of uninsured patients and prospective patients. If an accountable executive were made responsible for managing this problem by paying for all of this care on a case-by-case basis as third parties do, uncompensated care could be eliminated. Payment for each case would come from the institutional resources no longer required for uncompensated care. There is reason to hypothesize that with effective management, a significant amount of the resources currently absorbed by uncompensated care could be shifted from excessive inpatient care to more productive, innovative community initiatives. This paper outlines a six-point management program designed to increase the income and decrease the expense currently associated with uncompensated care, while improving quality, patient satisfaction, and outcomes. The program can be carried out by an individual provider organization, or as a collaborative program involving two or more organizations. Recommended are demonstration projects to test the feasibility and net cost or cost savings of such an approach, preferably starting in one-hospital towns.
authors.affiliation: Department of Health Policy, Jefferson Medical College, Thomas Jefferson University, 1015 Walnut St., Suite 115, Philadelphia, PA 19107, USA. Robert.sigmond@jefferson.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sigmond
mesh_terms: D003153:Community Health Services / Q000191:economics* / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D005376:Financial Management / Q000379:methods*; D005377:Financial Management, Hospital / Q000379:methods*; D006801:Humans; D007373:Interinstitutional Relations; D017057:Medically Uninsured; D018803:Models, Economic; D010350:Patient Credit and Collection; D020400:Provider-Sponsored Organizations; D017664:Uncompensated Care / Q000191:economics*; D014481:United States