title: Estimating uncompensated care charges at rural hospital emergency departments.
abstract: BACKGROUND
  Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits.
  
  
  OBJECTIVE
  To develop a national estimate of uncompensated care from patients utilizing the ED in rural hospitals.
  
  
  METHODS
  Clinical data from the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS-ED) from 1999 and 2000 were linked to billing data from South Carolina. National estimates of utilization and charges were calculated, with rurality and self-pay status being the variables of focus.
  
  
  RESULTS
  Applying South Carolina billing data to national clinical data yields a national estimate for 1999-2000 of nearly $441 billion in charges being generated through emergency departments, with self-pay patients representing 9.0% of total charges. Rural self-pay patients accounted for an estimated $3.5 billion in charges in 1999 and $5.3 billion in 2000. These charges may represent a total financial burden of more than $4 billion to rural hospitals.
  
  
  CONCLUSIONS
  Efforts should be made to reduce the uncompensated care burden on rural hospitals to ensure their viability. These efforts may include Medicaid/SCHIP expansions, FQHCs or RHCs, Critical Access Hospital Designation, or other indigent care programs that would reduce the need for self-pay patients to utilize EDs.
authors.affiliation: Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA. kevin.bennett@palmettohealth.org
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bennett
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.forename: Janice C
authors.initials: JC
authors.lastname: Probst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs; D006780:Hospitals, Rural / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D010350:Patient Credit and Collection; D013022:South Carolina; D017664:Uncompensated Care / Q000191:economics*; D014481:United States; D014505:Urban Population