Research Alert: March 13, 2024

COVID-19 Affected Rural and Urban Hospital Uncompensated Care

Uncompensated care consists of services provided that are never reimbursed, including charity care and unanticipated bad debt. High uncompensated care burden is a concern because it may contribute to smaller operating margins and rural hospital closures. This infographic uses Medicare Cost Report data for all acute care hospitals from the Healthcare Cost Report Information System (excluding Indian Health Services hospitals for which data are unavailable). The analysis includes a balanced panel of hospitals with cost reports for fiscal periods ending on or before 12/31/2021 (n=3,274).

Key Findings:

During COVID-19, compared to urban hospitals:

• Rural hospitals had smaller reductions in uncompensated care.
• Rural hospitals had a larger increase in operating expenses.

Additional Resources of Interest:

• Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership
• More information about the North Carolina Rural Health Research and Policy Analysis Center
• More information from the Rural Health Information Hub's topic guide: Hospitals