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Nonprofit hospitals' financial assistance policies often don't reflect community need, study finds

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Nonprofit hospitals' financial assistance policies often don't reflect community need, study finds

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Nonprofit hospitals in communities with the greatest financial needs offer eligibility for free care similar to that offered by hospitals in less disadvantaged communities, according to a new national study from Tulane University researchers. The study, published Nov. 2 in Health Affairs, analyzed 10 years of Internal Revenue Service data from more than 1,600 nonprofit hospitals.

Nonprofit hospitals receive billions in tax breaks in exchange for providing benefits to the communities they serve. In 2021, those tax exemptions were estimated to be worth $37.4 billion.

One of the most direct ways hospitals provide community benefits is by offering free or discounted care, known as charity care, to patients who meet certain income-based eligibility thresholds. However, there is no federal standard for these thresholds, and they vary widely from hospital to hospital, according to researchers.

"Hospitals receive large tax exemptions and are expected to reinvest in their communities," said lead study author Tatiane Santos, assistant professor in the Celia Scott Weatherhead School of Public Health and Tropical Medicine. "A key way of doing that is through charity care, which is especially important given the ongoing medical debt crisis."

The researchers examined whether hospitals' income-based eligibility thresholds for charity care differed according to community need, which the study's authors measured by the share of low-income residents in each county who lacked health insurance. They found that hospitals in high-need communities had similar eligibility thresholds to those in lower-need communities, where household income averaged approximately 180% of the federal poverty level, or roughly $60,000 annually for a family of four.


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