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Healthcare Insights

Hospitals with the highest total uncompensated care costs

Approximately 8% of the U.S. population did not have health insurance coverage in 2022. One study even indicates that about 18% of people would not be able to afford quality healthcare if they needed access to it today. With rising healthcare service costs, health systems are also seeing increases in charity care and other unreimbursed costs.   

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 20 hospitals with the highest total uncompensated care or unreimbursed costs. Data is sourced from the Medicare Cost Report and aggregated from the most recent 12-month interval tracked in our database. 

Hospitals with the highest total uncompensated care costs

RankHospital NameDefinitive IDCityStateTotal Uncompensated Care Unrimbursed CostsExplore Dataset
1NYC Health and Hospitals - Bellevue 2844New YorkNY$1,065,702,393 Explore
2NYC Health and Hospitals - Elmhurst 2879ElmhurstNY$769,601,333 Explore
3Ben Taub Hospital274186HoustonTX$765,193,085 Explore
4Parkland Health (FKA Parkland Health and Hospital System)3931DallasTX$716,663,272 Explore
5NYC Health and Hospitals - Jacobi 2755BronxNY$698,956,983 Explore
6Jackson Memorial Hospital845MiamiFL$697,632,191 Explore
7NYC Health and Hospitals - Kings County 2806BrooklynNY$690,091,685 Explore
8John Peter Smith Hospital 4147Fort WorthTX$623,418,901 Explore
9John H Stroger Jr Hospital of Cook County1140ChicagoIL$583,946,359 Explore
10NewYork-Presbyterian Weill Cornell Medical Center541974New YorkNY$563,124,874 Explore
11NYC Health and Hospitals - Lincoln 2753BronxNY$549,470,295 Explore
12Santa Clara Valley Medical Center596San JoseCA$528,026,884 Explore
13NYC Health and Hospitals - Queens 2878JamaicaNY$508,185,364 Explore
14NYC Health and Hospitals/South Brooklyn Health 2804BrooklynNY$436,413,058 Explore
15Montefiore Hospital - Moses Campus273024BronxNY$408,882,805 Explore
16Tisch Hospital2843New YorkNY$367,781,728 Explore
17AdventHealth Orlando873OrlandoFL$353,540,338 Explore
18NYC Health and Hospitals - Metropolitan 2842New YorkNY$342,630,234 Explore
19Grady Health System 996AtlantaGA$327,777,186 Explore
20University Hospital3859San AntonioTX$326,826,763 Explore

Fig. 1 Data is from the Definitive Healthcare HospitalView product and aggregated from the most recent 12-month interval tracked in our database. Data is sourced from the July 2023 Medicare Cost Report release. Accessed September 2023. 

Which hospitals have the highest uncompensated care costs? 

NYC Health and Hospitals - Bellevue has the highest total uncompensated care costs among U.S. hospitals with $1,065,702. This facility is the oldest hospital in the U.S. and has an academic affiliation with the New York University School of Medicine. It is also the flagship facility for the NY Health and Hospitals health system, which operates across all five boroughs.  

Coming in second place for hospitals with the highest uncompensated care costs is NYC Health and Hospitals - Elmhurst with total uncompensated care costs reaching $769,601,333. Another member of the NYC Health and Hospitals health system, this facility is the second oldest in New York City and serves as the primary hospital for over 1 million residents in Queens, one of the most ethnically and linguistically diverse communities in the United States. 

Rounding out the top three is Ben Taub Hospital with $765,193,085. Located in Houston, Texas, this level I trauma center is owned and operated by the Harris Health System and is staffed by the faculty, residents, and students from Baylor College of Medicine.   

Eleven of the top 20 hospitals by total uncompensated care costs are in New York, with eight in New York City alone. In addition, four are in Texas, and two are in Florida. These hospitals represent large metropolitan medical centers that serve large communities of people. Many of these facilities are located in lower income but highly populated areas where patients are more likely to be uninsured or unable to afford care. As a result, uncompensated care rates at these facilities remain much higher than in other parts of the country. 

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? 

Every hospital will take on at least some portion of uncompensated care, but some facilities can afford to take on more of this debt than others.  

Hospitals and other care facilities are not viable if they leave gaps in payment and must allocate funds to cover hospital bad debt and charity care costs. When this happens, the facility is left with less money to pay physicians and staff, obtain essential medical supplies, and provide other health and wellness initiatives. As a result, the overall quality of care at that facility will start to decline.  

Minimizing gaps in payment and bad debt is essential for a hospital to remain financially stable.  

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Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.