Healthcare Insights
Hospitals with the highest total uncompensated care costs
In 2024, 26.6 million Americans under the age of 65 were uninsured, placing financial strain on hospitals nationwide. These uncompensated care costs reflect the burden of providing care that isn’t reimbursed by patients or insurers. With recent policy moves focused on cuts to Medicaid, there are concerns that the number of uninsured could rise in the U.S., deepening the financial challenges faced by healthcare providers. This article looks at the hospitals with the highest uncompensated care costs and considers the wider implications for the U.S. healthcare system.
What is uncompensated care?
According to the American Hospital Association (AHA), uncompensated care is an overall measure of hospital care provided for which no payment was received from the patient or insurer. Hospitals typically provide uncompensated care to patients who are uninsured, impoverished, or who otherwise cannot pay for their medical care. The AHA also states that U.S. hospitals have provided more than $620 billion in uncompensated patient care over the last 20 years.
Total uncompensated care includes unreimbursed Medicaid costs, the Children’s Health Insurance Program (CHIP), state and local indigent care programs, charity care for both insured and uninsured patients, and non-Medicare and non-reimbursable Medicare bad debt expenses.
Using Definitive Healthcare’s HospitalView product, we created a list of the top 10 hospitals with the highest total uncompensated care or unreimbursed costs as a percentage of total operating expenses (OPEX). While some large institutions report higher overall uncompensated care costs (by total dollar amount alone), this percentage-based metric provides a clearer picture of the relative financial burden each hospital faces based on its operational scale.
| Rank | Hospital name | Definitive ID | City | State | Total uncompensated care unreimbursed costs | Total operating expenses | Uncompesated care as % of OPEX | Explore dataset |
|---|---|---|---|---|---|---|---|---|
| 1 | Texas Center for Infectious Disease (FKA San Antonio State Chest Hospital) | 5373 | San Antonio | TX | $16,355,109 | $10,979,259 | 149.0% | Explore |
| 2 | NYC Health and Hospitals - Queens (FKA Queens Hospital Center) | 2878 | Jamaica | NY | $662,948,160 | $721,008,832 | 91.9% | Explore |
| 3 | Turning Point Care Center (AKA Turning Point Hospital) | 970 | Moultrie | GA | $21,740,852 | $26,668,252 | 81.5% | Explore |
| 4 | NYC Health and Hospitals - Lincoln (FKA Lincoln Medical & Mental Health Center) | 2753 | Bronx | NY | $786,219,615 | $1,002,316,480 | 78.4% | Explore |
| 5 | Surgery Specialty Hospitals of America | 4010 | Pasadena | TX | $8,024,637 | $11,069,428 | 72.5% | Explore |
| 6 | Keck Hospital of USC (FKA USC University Hospital) | 440 | Los Angeles | CA | $1,139,069,768 | $1,777,593,600 | 64.1% | Explore |
| 7 | NYC Health and Hospitals - Bellevue (FKA Bellevue Hospital Center) | 2844 | New York | NY | $1,168,502,120 | $1,835,807,360 | 63.7% | Explore |
| 8 | Provident Hospital of Cook County | 1138 | Chicago | IL | $60,392,604 | $98,865,152 | 61.1% | Explore |
| 9 | NYC Health and Hospitals - Elmhurst (FKA Elmhurst Hospital Center) | 2879 | Elmhurst | NY | $658,633,802 | $1,119,998,976 | 58.8% | Explore |
| 10 | Elite Hospital Kingwood (FKA Kingwood Emergency Hospital) | 994606 | Humble | TX | $9,648,884 | $16,788,572 | 57.5% | Explore |
Fig. 1 Data is from the Definitive Healthcare HospitalView product and aggregated from the most recent 12-month interval tracked in our database, sourced from the Medicare Cost Report. Data accessed August 2026.
Which hospitals have the highest uncompensated care costs?
The list above highlights the top 10 hospitals with the highest uncompensated care costs as a percentage of their total operating expenses. By comparing uncompensated care costs to operating expenses, we assess how much of a hospital’s budget is consumed by treating patients who can’t pay.
While large hospitals may report high absolute uncompensated care costs, this percentage-based approach reveals which hospitals are most burdened by serving uninsured or underinsured populations.
For example, while Parkland Health in Dallas, Texas reported one of the highest total uncompensated care costs at over $1 billion, it did not appear in our top ten because that amount represents just over one-third of its operating expenses. This means that, proportionally, it is less financially strained than hospitals where uncompensated care might consume 50-60% of operating expenses.
Many of the hospitals on our list, such as those in the NYC Health + Hospitals system, serve as safety-net providers in densely populated, high-need areas. The list also includes public hospitals in Chicago and San Antonio, underscoring that this challenge spans geographic regions.
How is uncompensated care calculated?
Uncompensated care costs are calculated on a hospital-by-hospital basis.
First, the total uncompensated care charges are calculated by adding the hospital’s bad debts and its total charity care charges together. That number is then multiplied by the hospital’s cost-to-charge ratio, or the ratio of total expenses to gross patient and other operating revenue. The hospital’s uncompensated care costs are the resulting integer from this equation.
What are the effects of uncompensated care?
Uncompensated care places financial pressure on health systems, particularly those serving large uninsured or underinsured populations. Hospitals must absorb the cost of treating patients who cannot pay, which can lead to budget cuts, staff reductions, or even closures, especially in rural or safety-net facilities.
To offset these losses, some providers shift costs to privately insured patients, contributing to higher healthcare prices. Financial strain may also force hospitals to scale back critical but less profitable services, such as mental health care or community outreach programs.
These challenges can result in longer wait times, crowded emergency departments, and reduced access to care. Ultimately, uncompensated care exacerbates health disparities by disproportionately affecting underserved communities.
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