Physicians provided about $5.1 billion in uncompensated care to the uninsured in 2001

Physicians, not including those employed by hospitals or clinics, provided about $5.1 billion in uncompensated care to the uninsured in 2001, which includes donated time and forgone profits. While this figure seems much lower than the value of uncompensated care provided by hospitals, hospitals, unlike physicians, receive a substantial amount of public assistance for caring for the uninsured. Physicians, on the other hand, account for more than half of the private subsidies that underwrite the cost of uncompensated care. A study by researchers at the New York Academy of Medicine (NYAM), supported by the ACP Foundation and released in November 2003, found that over two thirds of internists treat uninsured patients who are unable to pay the physician’s usual fee, charging them a reduced or no fee and/or creating a payment plan. Approximately 60 percent of internists who provided any charity care provided between a quarter of an hour and five hours per month, while another 15 percent provided six to 10 hours monthly. Analysts warn that charitable physicians and the safety net, despite their valued role to the uninsured, are not substitutes for health insurance. According to the NYAM study, internists expressed concern that they were unable to provide uninsured patients the same quality of and continuity of care that insured patients received. Furthermore, changes in the structure and financing of the health care system have constrained physicians’ ability to cross-subsidize free care to uninsured patients. As a result, there has been a decline in the supply of physicians who are able to offer charity care -- from 76.3 percent in 1997 to 71.5 percent in 2001—while those who continue to offer such care are spending less time doing so. As the number of physicians able to provide free care declines, access to care for the uninsured is further curtailed. The percentage of uninsured persons with a usual source of care—which is already far lower than for any insured group—dropped to 2 6 percent in 2001, down from 6 percent in 1997, while the proportion of uninsured 7 persons seeing a physician dropped to 46.6 percent in 2001, from 51.5 percent in 1997.