Date of Award

Spring 4-12-2025

Embargo Period

4-29-2025

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Elinor Borgert

Second Advisor

Jillian Harvey

Third Advisor

Kit Simpson

Abstract

The financial burden of uncompensated care strains healthcare systems nationwide. In this study, we measured the uncompensated care for hospitals in SC based on outpatient surgeries (OP), inpatient visits (IP), and emergency department (ED) visits. We used the South Carolina (SC) Revenue and Fiscal Affairs Office (SCRFA) database from 2018-2023 to derive the mean charges for self-pay and indigent/charity care for each county for OP, IP, and ED visits. Without recent and publicly available cost-to-charge ratios for SC, we used the 2022 Centers for Medicare & Medicaid Services (CMS) Medicare 5% Limited Data Set (LDS) data to generate the unique payment-to-charge ratios for each of the three product lines. To better gauge potential Medicaid reimbursements, we then applied the published 2022 estimate for Medicaid to the Medicare fee index for SC. Multiplying these all together gave us an estimate for the average uncompensated care over the 5 years 2018-2023 for each of the 46 counties in SC. Our findings indicate that counties with higher telemedicine utilization generally experience lower levels of uncompensated care per capita, while counties with lower telemedicine utilization tend to bear a higher level. This trend reinforces the growing body of evidence suggesting that improved access telemedicine may reduce the need for more costly IP, OP, and ED visits, which are often the higher contributors of uncompensated care.

Rights

Copyright is held by the author. All rights reserved.

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