{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T13:54:29Z","timestamp":1775915669890,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,2,2]],"date-time":"2025-02-02T00:00:00Z","timestamp":1738454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In this second part of a series on medical debt and the costs of care, we examine the past and present financial protections for low\u2010income patients at nonprofit hospitals. Born of almshouses and religious orders, nonprofit hospitals were devoted at their founding to the care of the poor. However, over the course of the twentieth century, they became more focused on high\u2010priced care for paying patients. Federal regulations surrounding tax exemption and charity care have been loosened to allow hospitals to spend relatively little on financial assistance, contributing to inequitable and inadequate financial protections for low\u2010income patients.<\/jats:p>","DOI":"10.1002\/jhm.70002","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T01:34:13Z","timestamp":1738546453000},"page":"645-648","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Medical debt in America, Part II: Financial support for the most vulnerable"],"prefix":"10.1002","volume":"20","author":[{"given":"Blake N.","family":"Shultz","sequence":"first","affiliation":[{"name":"Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed M.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8790-2967","authenticated-orcid":false,"given":"Luke","family":"Messac","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.70001"},{"key":"e_1_2_8_3_1","article-title":"The burden of medical debt in the United States","author":"Rakshit S","year":"2024","journal-title":"Peterson\u2010KFF Health Syst Track"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.56021\/9780801850820"},{"key":"e_1_2_8_5_1","unstructured":"Consumer Financial Protection Bureau. Medical Debt Burden in the United States. February2022."},{"key":"e_1_2_8_6_1","article-title":"Hospital charity care: how it works and why it matters","author":"Levinson Z","journal-title":"KFF"},{"key":"e_1_2_8_7_1","article-title":"Nonprofit hospitals' community benefit requirements","author":"James J","year":"2016","journal-title":"Health Affairs Health Policy Brief"},{"key":"e_1_2_8_8_1","unstructured":"American Hospital Association. Fast Facts on U.S. Hospitals 2024.https:\/\/www.aha.org\/statistics\/fast-facts-us-hospitals"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.13413"},{"key":"e_1_2_8_10_1","unstructured":"Health Resources & Services Administration. Hill\u2010Burton Free and Reduced\u2010Cost Health Care. September2023.https:\/\/www.hrsa.gov\/get-health-care\/affordable\/hill-burton"},{"key":"e_1_2_8_11_1","article-title":"A hospital's duty: the past and present of the emergency medical treatment and active labor act","author":"Lee JM","year":"2024","journal-title":"Johns Hopkins Center Med Human Social Med"},{"key":"e_1_2_8_12_1","article-title":"The estimated value of tax exemption for nonprofit hospitals was about $28 billion in 2020","author":"Godwin J","journal-title":"KFF Health Costs"},{"key":"e_1_2_8_13_1","unstructured":"IRS revokes hospital's nonprofit status for failure to meet the community needs assessment requirements under Internal Revenue Code Section 501(r). Breazeale Sachse & Wilson LLP. August2017. Accessed December 30 2024.https:\/\/www.bswllp.com\/irs-revokes-hospitals-nonprofit-status-for-failure-to-meet-the-community-needs-assessment-requirements-under-internal-revenue-code-section-501r"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/00469580211028180"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.48232"},{"key":"e_1_2_8_16_1","article-title":"Hospital charity care: how it works and why it matters","author":"Levinson Z","year":"2022","journal-title":"KFF Health Costs"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13668"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.7415"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01615"},{"key":"e_1_2_8_20_1","article-title":"State options for making hospital financial assistance programs more accessible","author":"Kona M","year":"2024","journal-title":"Commonwealth Fund Blog"},{"key":"e_1_2_8_21_1","article-title":"Am I eligible?","author":"MillerB","year":"2024","journal-title":"Why financial assistance policies vary drastically between states. Lown Institute"},{"key":"e_1_2_8_22_1","unstructured":"Washington State Office of the Attorney General. AG Ferguson: Providence must provide $157.8 million in refunds and debt relief for unlawful medical charges to low\u2010income Washingtonians. Press release February 1 2024."},{"key":"e_1_2_8_23_1","unstructured":"Consumer Financial Protection Bureau. Medical debt and non\u2010profit hospital billing practices. Blog post October 12024. Accessed December 30 2024.https:\/\/www.consumerfinance.gov\/about-us\/blog\/medical-debt-and-non-profit-hospital-billing-practices\/"},{"issue":"2","key":"e_1_2_8_24_1","first-page":"33","article-title":"Tax\u2010exempt hospitals and their communities","volume":"6","author":"Tahk SC","year":"2015","journal-title":"Columbia J Tax Law"},{"key":"e_1_2_8_25_1","article-title":"100 million people in America are saddled with health care debt","author":"Levey N","year":"2022","journal-title":"KFF Health News"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.70002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T17:32:51Z","timestamp":1760635971000},"score":1,"resource":{"primary":{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/10.1002\/jhm.70002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,2]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/jhm.70002"],"URL":"https:\/\/doi.org\/10.1002\/jhm.70002","archive":["Portico"],"relation":{},"ISSN":["1553-5592","1553-5606"],"issn-type":[{"value":"1553-5592","type":"print"},{"value":"1553-5606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,2]]},"assertion":[{"value":"2024-11-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}