Healthcare Insights
Analyzing uncompensated care by hospital location
Uncompensated care is a measure for hospital care provided that did not receive any reimbursement from a payor. It includes the sum of a hospital’s “bad debt” and charity care. Bad debt is accrued when compensation is expected, but not received (i.e., a patient is unable or unwilling to pay their bill) and charity care is sometimes offered to a patient in need with no expectations of reimbursement, or at a reduced cost.
Because uncompensated care is not evenly distributed across hospitals, differences in hospital-level metrics can help identify where financial pressures are greatest, informing revenue cycle strategies, reimbursement opportunities, and broader decisions about markets, service lines, and resource allocation.
For this article, Definitive Healthcare analyzed both total and average uncompensated care costs throughout the U.S. by core-based statistical areas (CBSAs) and state.
Which areas are most affected by uncompensated care?
Fig. 1 — Average and median uncompensated care/unreimbursed costs and uncompensated care as a percentage of expenses among rural and urban U.S. hospitals. Analysis based on 5,850 active U.S. hospitals reporting data in Definitive Healthcare’s HospitalView product as of September 2026.
With a sample of 5,850 active U.S. hospitals, our data shows that urban hospitals carry substantially higher uncompensated care costs in dollar terms. Average uncompensated care costs were $21.3 million among urban hospitals, compared with $4.4 million among rural hospitals. Median costs were also more than twice as high in urban hospitals, at $5.1 million versus $2.4 million in rural hospitals.
However, uncompensated care represented a slightly larger share of expenses at rural hospitals: 5.5%, compared with 5.4% at urban hospitals. This suggests that while urban hospitals absorb greater uncompensated care costs overall, the financial burden is comparable relative to expenses, with rural hospitals facing a slightly higher proportionate burden.
Which CBSAs have the highest total uncompensated care costs?
The New York metro area has the highest total uncompensated care costs, at $12.0 billion across 142 hospitals. The Los Angeles metro area follows at $4.5 billion, followed by Dallas-Fort Worth at $3.2 billion and Houston at $2.8 billion. Other major metropolitan areas, including San Francisco, Chicago, and Miami, also rank among the CBSAs with the highest total uncompensated care costs.
Top 10 metropolitan areas by total uncompensated care costs
Fig. 2 — Top 10 CBSAs by total uncompensated care/unreimbursed costs, based on active U.S. hospitals reporting data in Definitive Healthcare’s HospitalView product as of September 2026.
Which CBSAs have the highest average uncompensated care costs?
The New York metro area has the highest average uncompensated care costs, at $84.8 million per hospital. Portland and Sacramento follow at $50.0 million and $49.8 million, respectively, while San Francisco ranks fourth at $47.9 million and San Diego ranks fifth at $40.3 million.
The rankings also show that the number of hospitals in a metro area does not necessarily correspond to higher average uncompensated care costs. Portland, for example, has just 19 hospitals in the analysis but ranks second for average costs, while Los Angeles has 127 hospitals but ranks sixth at $35.1 million.
Top 10 metropolitan areas by average uncompensated care costs
Fig. 3 — Top 10 CBSAs by average uncompensated care/unreimbursed costs, based on active U.S. hospitals reporting data in Definitive Healthcare’s HospitalView product as of September 2026. CBSAs with fewer than 10 hospitals reporting data excluded.
What portion of a hospital’s expenses does uncompensated care represent?
The share of expenses devoted to uncompensated care varies considerably across metro areas. Texas stands out, with three of the top 10 metro areas on the list, including El Paso, where uncompensated care represents 12.6% of hospital expenses. Dallas-Fort Worth and Austin follow at 10.0% each.
New York ranks fourth at 9.3%, despite having the highest average uncompensated care costs in dollar terms. Other metro areas with relatively high uncompensated care costs, including Portland, Sacramento, and San Francisco, account for 8.1%, 8.0% and 7.6% of expenses, respectively.
The findings highlight that higher uncompensated care costs do not necessarily translate into a higher share of hospital expenses. The relative financial burden varies by market, reflecting differences in both uncompensated care costs and overall hospital expenses.
Top 10 metro areas by uncompensated care as a share of expenses
Fig. 4 — Top 10 CBSAs by average uncompensated care/unreimbursed costs and uncompensated care as a percentage of expenses among active U.S. hospitals reporting data from Definitive Healthcare’s HospitalView product as of September 2026. CBSAs with fewer than 10 hospitals reporting data excluded.
Which states face the highest uncompensated care burden?
At the state level, New York has the highest average uncompensated care costs among the states analyzed, at $77.4 million per hospital. Uncompensated care also represents the largest share of hospital expenses in New York, at 9.2%. Texas ranks second at 8.2%, with Georgia, Florida and Oregon following at 7.0%, 6.9% and 6.9%, respectively.
The rankings also show that a high average dollar cost does not always correspond to the highest share of expenses. California, for example, has the third-highest average uncompensated care costs at $33.0 million but ranks seventh when measured as a share of expenses, at 6.8%.
Top 10 states by uncompensated care as a share of expenses
Fig. 5 — Top 10 states by average uncompensated care and unreimbursed costs and uncompensated care as a percentage of expenses among active U.S. hospitals reporting data from Definitive Healthcare’s HospitalView product as of September 2026.
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