Medical safety net shrinks with less charity care

CHICAGO, Mar 23 (Reuters) A shrinking portion of US doctors are providing free or reduced cost medical care to a rising number of patients who cannot afford treatment, leaving a smaller safety net for the uninsured, a survey released today said.

About 68 per cent of physicians provided charity care between 2004 and 2005, compared with 76 percent between 1996 and 1997, the study released by the Center for Studying Health System Change, a research group, said.

Factors driving the drop include heightened financial pressures on doctors from private and public insurers, and broad trends in the way doctors practice, the study suggested.

''Physicians are feeling really squeezed financially these days and that is having a direct impact on what they feel they can afford to do,'' said Peter Cunningham, a senior researcher at the research group.

At the same time, the number of people without health insurance has steadily risen to about 46 million. As the uninsured increasingly rely on public resources for medical care, taxpayers will bear more of the burden, the study suggested.

Doctors' financial predicament stems from a move away from a fee-for-service payment system toward health maintenance organizations, where insurers negotiate rates with large groups of doctors, Cunningham said.

While many of the restrictions on care from HMOs have eased, ''health plans are still vigorously negotiating payment rates with physicians,'' he said.

Physician practice trends are also likely influencing the steady decline in charity care. Doctors in solo or smaller practice groups are more likely to provide reduced cost or free care, but those practices are dwindling.

Doctors in large group practices have less control over which patients they see, and are more likely to face institutional barriers to seeing patients needing payment assistance.

The study also found that among specialists, surgeons tend to provide the most charity care, likely because they work more in hospitals where they would encounter uninsured patients.

Pediatricians are least likely to provide low-cost care.

The poll is part of an ongoing nationally representative telephone survey of physicians in the United States.

REUTERS SK RK1108