Center for Studying Health System Change

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Pressures on the Health Care Safety Net:

April 1999
Health Services Research

Ability to Obtain Medical Care for the Uninsured

September 9, 1998
Journal of the American Medical Association

A Changing Picture of Uncompensated Care

July/August 1997
Health Affairs

Staying in the Game:

March 1999
Research Report No. 03

Managed Care and Physicians' Provision of Charity Care

March 24-31, 1999
Journal of the American Medical Association, vol.281, no.12 (March 24-31, 1999): 1087-1092
Peter J. Cunningham, Joy M. Grossman, Robert F. St. Peter, Cara S. Lesser

ealth system changes may affect the ability of physicians to provide uncompensated care and may therefore result in decreased access to health care for people without health insurance. The authors looked at the Community Tracking Study’s survey data from a national sample of almost 11,000 physicians from 60 communities and found that 77.3 percent of them provided an average of 10.3 hours of charity care per week. Physicians who derive at least 85 percent of their practice revenue from managed care plans were considerably less likely to provide charity care than physicians with little involvement with managed care. In addition, physicians who practice in areas with high managed care penetration provide fewer hours of charity care than physicians in other areas, regardless of their own involvement in managed care. Differences in the provision of charity care also were affected by ownership of the practice and practice arrangements. The authors interpret the findings as indicating that financial pressures from managed care may be limiting the amount of charity care provided by physicians. This may result in reduced access to physicians among uninsured persons, and shift an even higher burden of uncompensated care onto traditional safety net providers, such as public hospitals and community health centers.

Free access to this article is available at the Journal of the American Medical Association Web site.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.