Doctors Less Likely to See Poor Patients, Study Shows

Times Staff Writer

American doctors, short of time and squeezed by hard-bargaining health plans, are less likely to see patients who can’t pay than they were a decade ago, according to a study to be released today.

A survey by the national Center for Studying Health System Change found that about two-thirds of U.S. doctors provided “charity care” -- down from three-fourths in 1996.

The trend is alarming, the study authors said, because it comes as the number of uninsured or underinsured Americans is on the rise. The study also found that charity care received by people without insurance declined by nearly one-fifth over the decade.

“Here is more evidence that there is fraying in parts of the safety net,” said Peter Cunningham, senior health researcher at the center and the study’s lead author.


The decrease in charity care -- service offered free or at reduced rates -- was seen across all regions and specialties, the study said.

Some doctors were more likely than others to treat those unable to pay. Surgeons, for example, were most likely to provide charity care -- probably, the study authors said, because they often are on call at hospitals and must treat uninsured patients.

Pediatricians were least likely to provide charity care. The study authors speculated that this is because many uninsured children are covered by government programs.

Samuel Fink, a general practitioner in Tarzana, said that doctors were increasingly feeling the pinch of reduced reimbursements by public programs like Medicare and Medi-Cal, which cover the elderly, the poor and the disabled.


“Every patient you see costs something,” said Fink, who has been practicing for 18 years. “There really is less money to go around.” All the same, he said most doctors still “are willing to do what they can to help.”

Researchers at the Washington-based center interviewed more than 6,600 physicians by phone in late 2004 and early 2005.

They found that doctors in private practice were more likely than those in physician groups or on hospital staffs to provide charity care because they have more autonomy. But that ability is decreasing.

“In the past, physicians could sort of recoup some of their losses for uncompensated care by charging paying patients more,” Cunningham said. “But they are increasingly unable to do that.”


That’s mostly because of managed healthcare, Cunningham said. Health plans negotiate flat rates with hospitals and doctors groups. Private practitioners are bound by those rates if they accept insured patients, even if they were not part of the bargaining and their costs are higher. The trend also is pushing more doctors away from private practice and into groups to defray overhead costs -- a setting where they have less discretion to accept charity cases.

Moreover, doctors in general are facing growing patient loads, leaving less time for charity, Cunningham said.

“Part of it is, there is just more stuff out there,” he said, “more drugs, more diagnoses, a lot more stuff medicine can do and people want to try. You see evidence of that in longer waiting times.”

Although the study doesn’t make any policy recommendations, Cunningham said the solution was evident: either more people will have to be insured or taxpayers will have to pay for more free health clinics, public hospitals and funding for programs such as Medi-Cal, California’s health program for the poor and disabled.


“Traditionally the private system delivered a good amount of private charity, but it is becoming increasingly more difficult,” Cunningham said. “That means the uninsured will have to find help from a more public safety net.”