How much charity care do hospitals provide?

US hospitals report $33.0 billion of charity care in their latest Medicare cost reports. That sounds large until you divide it: the median hospital's charity care comes to 1.4% of its net patient revenue, and a quarter of hospitals report 0.64% or less. Then there is the other end of the distribution, where a small group of public safety-net hospitals give away amounts that rival their entire revenue base.

Charity care sits at the center of a live fight over whether nonprofit hospitals earn their tax exemptions. We are not going to adjudicate that here. We are going to do something more useful: publish the distribution, name the outliers, and define the terms, because most charity care arguments fall apart at the definitions.

Three numbers that get conflated

Cost reports carry three related figures, and they are not interchangeable.

Charity care is care the hospital decided in advance not to charge for, under its financial assistance policy. The patient qualified; the hospital wrote it off as charity. Sector total: $33.0 billion.

Bad debt is care the hospital billed and could not collect. It wanted to be paid. Sector total: $51.9 billion, half again larger than charity care.

Uncompensated care is the umbrella measure of unreimbursed care burdens. Sector total as reported: $44.8 billion.

The distinction matters because bad debt frequently gets marketed as generosity. A bill sent to a patient who could never pay it, written off after collections failed, is not a gift. Cost reports keep the categories straight, hospital by hospital.

The distribution: half of hospitals under 1.4%

Across the 4,228 hospitals reporting both charity care and revenue, the median is 1.4% of net patient revenue. The middle half sits between 0.64% and 3.1%. The top decile reports 5.9% or more. Uncompensated care follows the same shape a step higher: a 2.8% median, top decile above 8.4%.

KFF found a similar landmark in 2020 cost reports, half of hospitals at or under 1.4% of operating expenses. Different denominator, same shape, and their figure is six years old now. The number has barely moved, which is itself informative: charity care burdens are a stable, structural feature of the sector, not a pandemic artifact.

What the median hides is how unevenly the burden lands. Charity care is not spread across the sector like a tax. It concentrates on a specific class of institution.

The safety-net tail carries the load

The top of the charity care table is not the famous academic medical centers. It is the public safety nets. Harris Health System in Houston reported $736 million of charity care against $748 million of net patient revenue, 98.4%, nearly as much care given away as collected for. Parkland, the Dallas County hospital district, reported $728 million, 62.1% of NPR. JPS Health Network in Fort Worth: $339 million, 42.7%. Grady Memorial in Atlanta: $280 million, 16.8%.

Three of the four are Texas county systems, in the largest state that did not expand Medicaid. Where public coverage stops, county taxpayers and public hospital budgets pick up the difference, and it lands in these filings as charity care at percentages no private hospital approaches.

What this data can and cannot settle

The exemption debate asks whether nonprofit hospitals provide community benefit worth what the exemption costs. Cost report charity care is one input, not the answer. It excludes other community benefit categories hospitals claim, like Medicaid shortfalls, research, and training, and hospitals keep some definitional discretion. A hospital at 0.5% of revenue is not automatically a bad actor, and one at 4% is not automatically a saint; payer mix and geography sort hospitals before policy choices enter.

What the data settles is the baseline: what each hospital reported, in a public filing, under a consistent definition. Whichever side of the argument you are on, the reported numbers beat press releases. Margin context belongs in the same frame: a sector where the median operator loses money on patient care has limited room to expand giveaways, and a sector where the top decile clears 23% margins invites the question anyway.

Look up any hospital

Every profile carries its charity care, uncompensated care, and bad debt free, next to its financials, in the directory. If you are writing about a specific hospital's community benefit, the filing beats the annual report.

FAQ

What counts as charity care? Care provided free or discounted under a hospital's financial assistance policy, where the patient qualified and the hospital never expected payment. It excludes bad debt, which is billed care that went uncollected.

How much charity care does the average hospital provide? The median hospital reports charity care equal to 1.4% of net patient revenue. The middle half sits between 0.64% and 3.1%; the top decile exceeds 5.9%.

What is uncompensated care? The broader measure of care hospitals were not paid for. Sector total: $44.8 billion, against $33.0 billion of charity care alone and $51.9 billion of bad debt.

Sources and method

Computed from Medicare cost reports (CMS HCRIS), most recent filed year per hospital. Coverage: 4,237 hospitals report charity care; ratios use the 4,228 with both charity care and net patient revenue, 4,511 for uncompensated care. Figures are hospital-level and self-reported. Medians throughout, never means. Source detail: Medicare cost reports, explained. Revenue definitions: net patient revenue.

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