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Charity Care Up At Missouri Hospitals


Charity care at Missouri hospitals has been on the rise in recent years, and urban and rural hospitals are handling this increase differently.  

That’s according to a new report from the Missouri Foundation for Health and the St. Louis Business Coalition, which examined 40 hospitals located around the St. Louis area and in some rural counties between 2004 and 2008.

Charity care is basically the care hospitals provide without getting paid for it. Among the hospitals surveyed, charity care went from $61.7 million in 2004 to $159.5 million in 2008. The study also found that hospitals’ bad-debt expenses, where payment is expected from patients but not fully collected, went from $137 million in 2004 to nearly $257 million in 2008.

Ryan Barker, a lead editor of the study, says the increases coincided with a major reduction in the state’s Medicaid program in 2005 and a rise in the state’s uninsured population (from 13.6 percent to 14.3 percent between '04 and '08).  But Barker says hospitals in urban regions were generally better able absorb those costs. He also says urban health systems as a whole were better equipped to handle a growing number of patients without insurance. 

“In St. Louis, the safety net was able to pick up some of those patients that lost their Medicaid coverage, provide primary care and keep them out of the hospitals, which tampered down the increase in uninsured [people] accessing the emergency room,” says Barker. 

Barker says rural areas had fewer health centers to help with the situation.

Despite an increase in charity care, the report also found that compared to hospitals’ overall finances, charity care remained at “a relatively low level,” at about 1.7 percent of hospitals’ overall operating revenue in 2008.


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