{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:42:18Z","timestamp":1792482138153,"version":"4.5.0"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate hospital and community characteristics associated with attributes of charity care policies. Charity care is a highly utilized avenue for medical debt relief. Hospitals are allowed some discretion when setting charity care policies, yielding heterogeneity in charity care generosity and availability to patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We conducted a cross\u2010sectional study using data on charity care policies from US hospitals collected through hospital websites and direct email and phone contact between September 2023 and April 2025 by the Lown Institute.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We reviewed 2418 hospitals from 50 US states, including non\u2010profit, for\u2010profit, and government\u2010owned hospitals. The primary outcomes were the likelihood that certain hospital characteristics were associated with offering fully or partially discounted care and income limits for patient eligibility. Additional outcomes include eligibility for the underinsured, patients with large bills, residency requirements, and use of presumptive eligibility screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>System affiliation was positively associated with offering fully discounted (Est, 90.5%; 95% CI, 88.9%\u201392.0% compared with Est, 78.9%; 95% CI, 76.4%\u201381.5% for non\u2010affiliated hospitals) and partially discounted care (Est, 85.5%; 95% CI, 83.5%\u201387.2% compared with Est, 77.1%; 95% CI, 74.2%\u201380.0% for non\u2010affiliated hospitals), and was associated with a significant percentage\u2010point increase in charity care income thresholds (32.69, 95% CI, 25.20\u201340.17; for fully discounted care). Non\u2010profit hospitals reported the highest likelihood of offering both fully (Est, 96.7%; 95% CI, 95.8%\u201397.7%) and partially discounted care (Est, 85.5%; 95% CI, 83.5%\u201387.2%), and were significantly more likely to use presumptive eligibility screening (Est, 82.7%; 95% CI, 80.8%\u201384.6%) compared with for\u2010profit hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, tax\u2010exemption status, system affiliation, and community socio\u2010economic and legislative factors were associated with more expansive and generous charity care policies. Policymakers can consider hospital incentives and capabilities when designing policies to address medical debt.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70170","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:07:42Z","timestamp":1790140062000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital and Community Attributes Associated With Charity Care Policy Generosity"],"prefix":"10.1111","volume":"61","author":[{"given":"Nicholas","family":"Wong","sequence":"first","affiliation":[{"name":"USC Schaeffer Center for Health Policy and Economics  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Randall","sequence":"additional","affiliation":[{"name":"USC Schaeffer Center for Health Policy and Economics  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8736-7862","authenticated-orcid":false,"given":"Erin","family":"Trish","sequence":"additional","affiliation":[{"name":"USC Schaeffer Center for Health Policy and Economics  Los Angeles California USA"},{"name":"USC Mann School of Pharmacy and Pharmaceutical Sciences  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4948-1872","authenticated-orcid":false,"given":"Erin","family":"Duffy","sequence":"additional","affiliation":[{"name":"USC Schaeffer Center for Health Policy and Economics  Los Angeles California USA"},{"name":"USC Price School of Public Policy  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"A.Montero L.Lopes M.Presiado andL.Hamel \u201cAmericans' Challenges With Health Care Costs \u201dKFF (2024) https:\/\/www.kff.org\/health\u2010costs\/issue\u2010brief\/americans\u2010challenges\u2010with\u2010health\u2010care\u2010costs\/."},{"key":"e_1_2_8_3_1","unstructured":"\u201cCFPB Takes Aim at Double Billing and Inflated Charges in Medical Debt Collection \u201dConsumer Financial Protection Bureau (2024) https:\/\/www.consumerfinance.gov\/about\u2010us\/newsroom\/cfpb\u2010takes\u2010aim\u2010at\u2010double\u2010billing\u2010and\u2010inflated\u2010charges\u2010in\u2010medical\u2010debt\u2010collection\/."},{"key":"e_1_2_8_4_1","unstructured":"Internal Revenue Service \u201cFinancial Assistance Policies (FAPS) \u201d(2025) https:\/\/www.irs.gov\/charities\u2010non\u2010profits\/financial\u2010assistance\u2010policies\u2010faps."},{"key":"e_1_2_8_5_1","unstructured":"\u201cFact Sheet: Uncompensated Hospital Care \u201dAmerican Hospital Association (2022) https:\/\/www.aha.org\/fact\u2010sheets\/2020\u201001\u201006\u2010fact\u2010sheet\u2010uncompensated\u2010hospital\u2010care\u2010cost."},{"key":"e_1_2_8_6_1","unstructured":"M.Bella K.Davis H.Allen et\u00a0al. \u201cReport to Congress on Medicaid and CHIP \u201d(2022) Medicaid and CHIP Payment and Access Commission (2022) https:\/\/www.macpac.gov\/wp\u2010content\/uploads\/2022\/03\/March\u20102022\u2010Report\u2010to\u2010Congress\u2010on\u2010Medicaid\u2010and\u2010CHIP.pdf."},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01615"},{"key":"e_1_2_8_8_1","unstructured":"M.KonaandV.Raimugia \u201cState Protections Against Medical Debt: A Look at Policies Across the U.S. \u201dThe Commonwealth Fund (2023) https:\/\/www.commonwealthfund.org\/publications\/fund\u2010reports\/2025\/jul\/state\u2010protections\u2010against\u2010medical\u2010debt\u2010look\u2010policies\u2010across\u2010us."},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.01627"},{"key":"e_1_2_8_10_1","unstructured":"D.Muoio \u201cNonprofit Hospitals' Community Benefit Spending Faces Lawmaker Scrutiny \u201dFierce Healthcare (2025) https:\/\/www.fiercehealthcare.com\/providers\/nonprofit\u2010hospitals\u2010community\u2010benefit\u2010spending\u2010faces\u2010lawmaker\u2010scrutiny."},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.13413"},{"key":"e_1_2_8_12_1","unstructured":"D.Muoio \u201cNonprofit Hospitals Delivered $149B Total Community Benefit in 2022: AHA \u201dFierce Healthcare (2025) https:\/\/www.fiercehealthcare.com\/providers\/nonprofit\u2010hospitals\u2010delivered\u2010149b\u2010total\u2010community\u2010benefit\u20102022\u2010aha."},{"key":"e_1_2_8_13_1","unstructured":"Lown Institute Hospitals Index \u201cHospital Financial Assistance and Debt Collection Policies: A National Dataset \u201dVintage (2025) https:\/\/lownhospitalsindex.org\/report\u2010hospital\u2010financial\u2010assistance\u2010and\u2010debt\u2010collection\u2010policies\/#data."},{"key":"e_1_2_8_14_1","unstructured":"\u201cRAND Hospital Data \u201daccessed July 7 2025 https:\/\/www.hospitaldatasets.org\/."},{"key":"e_1_2_8_15_1","unstructured":"United States Census Bureau \u201cAmerican Communities Survey 5\u2010Year Estimates Subject Tables Table\u00a0S1902 Income in the Past 12 Months (in 2022 Inflation\u2010Adjusted Dollars) \u201daccessed June 24 2025 https:\/\/data.census.gov\/table\/ACSST1Y2022.S1901."},{"key":"e_1_2_8_16_1","unstructured":"M.KonaandV.Raimugia \u201cState Protections Against Medical Debt: A Look at Policies Across the U.S. \u201dThe Commonwealth Fund (2023) https:\/\/www.commonwealthfund.org\/publications\/fund\u2010reports\/2023\/sep\/state\u2010protections\u2010medical\u2010debt\u2010policies\u2010across\u2010us."}],"container-title":["Health Services 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