Oregon Community Benefit Reform Influenced Not-For-Profit Hospitals' Charity Care And Medical Debt Write-Off

Area of Science:

• Health Services Research
• Public Health Policy
• Hospital Financial Management

Background:

• Not-for-profit hospitals are mandated to offer community benefits.
• Hospital community benefit spending has stagnated despite regulatory efforts.
• Oregon implemented a phased policy to boost hospital community investment.

Purpose of the Study:

• To evaluate the impact of Oregon's phase 1 policy on hospital community benefit spending.
• To assess changes in charity care and bad debt following new financial assistance and medical debt protection requirements.

Main Methods:

• Utilized a nearest-neighbor matching difference-in-differences analysis.
• Examined hospital financial data from 2016 to 2022.
• Compared Oregon hospitals subject to the new policy with control hospitals.

Main Results:

• Phase 1 requirements were linked to an increase in charity care spending ($423,000 per hospital).
• Phase 1 also correlated with higher bad debt levels ($846,000 per hospital).
• The impact of minimum community benefit spending floors (phase 2) requires further study.

Conclusions:

• Oregon's initial policy phase successfully increased charity care and bad debt.
• The findings suggest policy interventions can influence hospital financial assistance and debt management.
• Long-term effects of comprehensive community benefit policies warrant ongoing investigation.