Study shows a drop in charity care in the US
Michael Romano

A decline in the number of practicing physicians in the US who provide charity care, has triggered concerns from some experts about access by poor patients to basic medical services, a new study reveals. The percentage of physicians who provide charity care dropped to 72 per cent in 1999 from 76 per cent in 1997, according to a study released recently by the Washington-based Center for Studying Health System Change.

‘‘Policy makers should take note that an important part of the safety net-physician charity care is in danger of fraying,’’ said Paul Ginsburg, president of the organization, a nonpartisan policy research organization funded by the Robert Wood Johnson Foundation. ‘‘If insurance costs continue to rise rapidly and the number of physicians providing charity care declines, access to care for the poor and uninsured will be in jeopardy,” he adds.

The study shows that the number of physicians providing charity care fell to 2,61,000 from 2,65,000 during the two-year period. Meanwhile, the overall number of doctors involved in patient care increased during the period to about 3,63,000 from 3,47,000. Doctors who do provide charity care devoted an average of about 11 hours per month to the poor, the study says.‘‘The decline in physicians providing charity care may be related in part to changes in the medical marketplace, including an increase in managed care and the trend away from physician ownership of practices during the 1990s,’’ according to the report. While the immediate impact on the poor is likely to be ‘‘negligible,’’ according to the lead author of the study, the long-term outlook could be grim. ‘‘The proportion of physicians willing to provide charity care is shrinking,’’ said Marie Reed, a research analyst with the organization. ‘‘While demand for charity care is likely to increase if rising healthcare costs add to the ranks of the uninsured, HSC officials say the number of practicing physicians is growing at a rate of only about 1 per cent per year compared with about 3 per cent in the 1990s, according to recent estimates.

Reed says the slowed growth raises concerns about whether there will be enough new doctors to offset declines in the number of physicians providing charity care. Officials said a decrease in charity care by physicians translates directly into increased traffic-and costs-for hospital emergency departments and academic medical centers, often the last resort for the poor.‘‘The safety net, which includes a variety of institutional providers as well as physicians in private practice, remains fragile,’’ the study notes.

Among the factors cited for the trend: r More physicians who are employees of medical practices-rather than owners-are less able to provide charity care than doctors who have their own

practices. r Physicians are under more financial pressure because of lowered reimbursement rates, leaving them unwilling to provide free care.

Physicians have less time for charity care because of the increased demands of administrative duties.