South Carolina hospitals unite to share charity care burden

Four Columbia-area hospitals formed a partnership in 1984 to more equitably distribute responsibility for care of the medically indigent. This was primarily a response to the state's weak Medicaid program, which funded only 12 inpatient days per year per client. Resulting shortfalls especially crippled regional tertiary care facilities. The partnership included Richland Memorial, Baptist Medical Center, and Providence, all in Richland County; and Lexington County Hospital. These facilities provide service to about 1 million of South Carolina's 3 million people. Richland, although exclusively receiving county tax funds, questioned its provision of unlimited indigent care because of inadequate payment and unsponsored patients. Providence, expanding into a referral hospital with only 15 percent of the market share, wanted county funds available to any facility serving county residents. When Richland county opened its indigent fund to all the county's hospitals, recognizing the charity care private hospitals had been providing without county support, the hospitals formed the Midlands Hospitals Indigent Care Partnership. Each contributed to a fund to support charity care. The program's major fault was underestimating the hospitals' true cost of providing indigent care because it failed to account for the more intense use of services by the medically indigent population. The project accomplished its objectives of focusing public attention on the problem, resulting in passage of a state law to expand Medicaid benefits and other state initiatives to address the problem.