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Show Burdens Encountered By the Uninsured in the Search for Hospital Care: Are Tax-Exempt Hospitals Fulfilling Their Charitable Obligations: Jennifer M. Lambert Figure 3. Responses to Financial Assistance & Proof-of-Pnyment RESPONSES TO QUESTIONS 4, 5, 6, & 7 As shown in figures 2, 3, and 4, the answers were rather insignificant between NFP and for-profit hospitals. In contrast to the initial hypothesis that NFP hospitals would be more helpful and informative, the hospital that was most direct and accommodating in terms of thoroughly explaining the services that might be covered, the available programs, and the steps that must be taken prior to, during, or after services rendered was the urban for-profit hospital. Incidentally, the same hospital was one of two hospitals (the other a NFP hospital) to explain that everyone is admitted to the ER regardless of ability to pay or proof-of-payment. As well, payment is discussed with a financial counselor to assess financial need after admittance to the hospital. Six of the seven hospitals inferred that paperwork, including proof-of-payment was necessary in order to receive care. The most astounding information discovered was the fact that none of the hospitals contacted had information on their charity care programs. None of the seven hospitals had any printed information that could be provided to a potential or admitted patient. Furthermore, three of the hospitals' front-line people-defined as the initial hospital staff that was contacted regarding financial aid and assistance-were unaware of any free care or charity care policy, much less any written policies. The other four hospitals claimed that anything written, other than a hardship application, SFCA (Special Financial Consideration Application) form, or Medicaid forms, did not exist. One NFP hospital declared that there are no written charity care policies posted within the hospital. In contrast with the hospital survey results, newspaper articles recently published in Utah papers declare that Utah hospitals contribute millions of dollars in charity care every year to patients who are unable to pay, which is burdening the system (Lampros 2004). Although this essay does not contest the amount of charity care provided by these hospitals, it is questionable as to why NFP hospitals, who receive generous tax exemptions, are insignificantly distinguishable from for-profit utilities. Furthermore, Utah's NFP hospitals are reported as feeling overburdened with charity, yet the amount of care appears to be relatively equal to for-profit hospitals. Conclusion In response to the various questions posed in the introduction, the epidemic of uninsurance will continue to create controversy until our uninsured are insured. The hospital indus- try will continue to write-off bad debt incurred by the uninsured while Americans and Utahns alike are without health insurance. Employers may respond by providing health insurance to their employees. Nevertheless, an employer's generosity will not solve the uninsurance conundrum. Thus, we turn to hospitals. Hospitals are obligated to provide community benefits and charity care to individuals. It is my assessment that 501 (c) (3) entities are not fulfilling their obligations to their communities. Not-for-profit hospitals who receive charitable tax-exempt status should provide significantly more than they are currently giving. With consideration of the hospital industry's (speaking of NFP hospitals) excessive net income, with respect to the tax benefits they receive, no argument can outweigh their charitable obligations. In addition, the study conducted of Utah hospitals finds that many hospitals-holding the NFP more liable-are not doing their part by providing information to the uninsured and indigent in Utah. Although the hospitals claim to provide charity care, many, if not most, individuals are unaware of such existing programs. Hospitals are fiscally compensated with the understanding that they must act as a "charitable" institution, and further provide charity benefits, which also includes providing information to the community about available programs that provide reduced-cost or free care to the uninsured and indigent. Because such entities are not fulfilling their obligations, many outstanding hospital medical accounts are the cause of bankruptcy and bad credit ratings among the uninsured and indigent. However, this article does not intend to discount the small acts through which hospitals give back to the community; Utah's hospitals are among those that provide some charity care. However, given the statistics of this study, and the amount of care that is not provided that could and should be, the conclusion is that the amount of community care given to Utah patients is not proportionately great enough to justify federal 501 (c)(3) status, which provides significant tax benefits. It is suggested that the obligations of a 501 (c)(3) hospital are more proportionate to the tax benefits received. Furthermore, it is proposed that the government more clearly define "charitable contribution" and charity care, in addition to regulating the actions of the many 501(c)(3)s that are currently in operation. References Abelson, Reed. 2004. "Hospital Industry Is in 'Crisis.'" New York Times. <http://www.nytimes.com/2OO4/O2/O5/business/O5place .html> (6 February 2004). Academy Health. 2003. Glossary of terms commonly used in healthcare. 5. Cassavetes, Nick. 2002. John Q. Motion picture. Film viewed 10 June 2004. Centers for Medicare & Medicaid Services (CMS). 2004. "EMTALA." <http://www.cms.hhs.gov/providers/emtala/default.asp> (1 April 2005). 30 |
