Research Alert: June 13, 2018

Geographic Variation in Uncompensated Care Between Rural and Urban Hospitals

This brief uses data from 2014-2016 Medicare Cost Report Worksheet S-10 to compare uncompensated care in rural and urban hospitals and to describe how it varies across regions of the country. This study finds substantial differences in reported uncompensated care as a percent of operating expense between rural and urban hospitals and among regions of the country. Between 2014 and 2016, median uncompensated care as a percentage of operating expense declined across critical access hospitals (CAHs), other rural hospitals, and urban hospitals, and also declined across census regions. However, it increased for hospitals with less than $20 million in net patient revenue and decreased for hospitals with more than $20 million in net patient revenue. In 2016, the hospitals with the highest median uncompensated care as a percentage of operating expense were CAHs, other rural hospitals, and urban hospitals in the South. Among hospital types, other rural hospitals had the highest median percentage of uncompensated care, and urban hospitals had the lowest median percentage. Nine of the 10 states with the highest median uncompensated care as a percentage of operating expense were located in the South.

Additional Resources of Interest:

• Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
• Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
• More information about the North Carolina Rural Health Research and Policy Analysis Center
• More information from the Rural Health Information Hub's topic guides: Hospitals, Rural Health Policy