Mark Rukavina
The Access Project

Kathy Melley
Community Catalyst
617-275-2861/857-366-1599 (m)


(Boston, MA)— Many non-profit hospitals are not doing enough to let needy patients know about whether they qualify for hospital charity care programs and how to apply for assistance, according to a report released today by The Access Project and Community Catalyst. 

The report, Best Kept Secrets, presents the findings of a survey that looked at whether non-profit hospitals are meeting the voluntary guidelines established by the American Hospital Association (AHA) regarding billing and collection practices for uninsured and underinsured patients. Non-profit hospitals are expected to offer community benefits, including charity care, in exchange for the tax exemptions they receive as charitable institutions.  Charity care programs provide free or discounted care to patients who meet hospitals’ financial assistance criteria. The AHA guidelines call on hospitals to have clear, written policies to help patients determine if they qualify for charity care and to make these policies available to patients and the public.

The report is based on a survey of a representative sample of non-profit hospitals nationally that was conducted by The Access Project in the summer of 2009.  The survey found that while most hospitals mentioned the existence of charity care programs on either their websites or over the telephone, only about a quarter provided information regarding eligibility for charity care.  Fewer than half provided a charity care application form. Fewer than 1 in 10 provided information on their websites that listed the discounts available to people at different income levels.

“This report illustrates that voluntary guidelines are ineffective,” said Access Project director Mark Rukavina.  “Given the state of our economy and the insecurity Americans feel regarding health care costs, hospital charity care is and will continue to be an important part of our health care safety net.  Both federal and state governments must ensure that hospitals receiving tax breaks are also fulfilling their charitable obligations.”

The report is timely because provisions in the national health care reform law (the Patient Protection and Affordable Care Act) impose new requirements on tax-exempt hospitals. Under the law, hospitals must establish written financial assistance policies that clearly specify eligibility criteria and widely publicize these policies.  They are also prohibited from taking extraordinary collection actions before making a reasonable effort to determine if patients qualify for financial assistance. These provisions represent the most significant revisions to the community benefit standards for hospitals receiving federal tax exemptions since1969, following passage of the laws that established the Medicare and Medicaid programs.

Dawn D’Amico, who sought care at a hospital in Pennsylvania, found out about the existence of charity care programs through an article in a local newspaper.  When she called her hospital to ask for help, staff denied that the hospital offered charity care.  She only succeeded in getting a charity care application after directing hospital staff to an article on the Web.  She said, “If hospitals are being awarded tax breaks for providing these programs, someone needs to make sure they are actually doing so.  I just can’t imagine how many other people were denied care that they desperately needed.”

Carol Pryor, lead author of the report and Policy Director at The Access Project, said “Our survey showed that many uninsured and underinsured Americans are not able to get information on charity care policies. This isn’t trivial.  Many studies show that families are badly hurt by unaffordable medical bills – they don’t get the care they need or they do without basic necessities and incur crippling debt in order to pay them off.”

According to Jessica Curtis, director of the Hospital Accountability Project at Community Catalyst, “These findings by our partner The Access Project are surprising and disappointing given that hospital billing and collection practices have been closely scrutinized over the last decade by Congress and many state governments.  It will be important for the federal government to develop regulations that establish very clear standards for tax-exempt hospitals and then monitor hospital behavior to ensure that they comply with the new requirements.” 

The random sample of 99 non-profit hospitals in the current survey was selected from the 2009 AHA handbook of hospitals. The research assessed whether hospitals were complying with the AHA billing and collection guidelines by searching hospital websites for information and by calling hospitals to inquire about the availability of charity care and the criteria for eligibility. This is the second Access Project report examining the effectiveness of the AHA voluntary guidelines in shaping hospital billing and collection practices (the first report is available at

The “Best Kept Secrets” report can be accessed at:

About The Access Project
The Access Project is a research and advocacy organization that has worked to improve health and health care access since 1998. Its mission is to strengthen community action, promote social change, and improve health, especially for those most vulnerable.

About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all.  Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system.  With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone – especially vulnerable members of society.  For more information, visit