A Growing Hole in the Safety Net: Physician Charity Care Declines Again
By Peter J. Cunningham and Jessica H. May
Center for Studying Health System Change
March 2006
Continuing a decade-long trend, the proportion of U.S. physicians providing charity care dropped to 68 percent in 2004-05 from 76 percent in 1996-97, according to a national study from the Center for Studying Health System Change (HSC). The ongoing decline in physician charity care is alarming given the increase in the number of uninsured people, particularly during the first half of the decade. Declines in charity care were observed across most major specialties, practice types, practice income levels and geographic regions. Increasing financial pressures and changes in practice arrangements may account in part for the continuing decrease in physician charity care.
http://www.hschange.com/CONTENT/826/
Comment: By Don McCanne, M.D.
Grocery stores do not provide free food for those unable to pay. Landlords do not provide free housing for those unable to pay. Department stores do not provide free clothing for those unable to pay. Health insurers do not provide free insurance for those unable to pay. Yet physicians often do provide free health care to those unable to pay. It is one of the reasons why practitioners of the healing arts are held in high esteem.
The decline in physician charity care is very troubling news, but does this mean that there is a decline in physician altruism? Though altruism stems from within, it is molded by externalities. The health care environment is evolving.
Physicians within integrated health systems are offered little opportunity to provide charity care within their systems. Physicians in larger group practices have less influence in decisions over the level of charity care to be provided by their group. The growth in community health centers offers a release valve allowing primary care physicians to rely more heavily on paying patients to meet their ever-increasing overhead expenses. The health care environment has become less conducive to germinating the seeds of altruism.
Changing the health care environment would be more effective than trying to manipulate physician ethics. A national health insurance program would eliminate the need for physician charity care. Need we say more?