Charity Care, Uncompensated Care, and Medicaid Patient Volume Among 340B and Non-340B Hospitals

Background The 340B Drug Pricing Program allows eligible safety-net hospitals and clinics to purchase outpatient drugs from manufacturers at discounted prices, creating revenue that can support care for low-income and uninsured patients. As the program has expanded, questions have emerged about whether participating hospitals’ reported financial assistance and patient-volume measures align with the program’s intended objectives. Objectives We compared 340B and non-340B hospitals using reported measures related to care for uninsured and underserved patients, including charity care, charity care for uninsured patients, uncompensated care, and Medicaid admission days. Methods We conducted a cross-sectional analysis comparing unadjusted mean values across 340B and non-340B hospital categories. 340B designation was derived by linking hospitals in RAND-transposed CMS HCRIS hospital cost report data to HRSA 340B covered-entity records. Hospitals identified as active 340B covered entities during the relevant reporting period were classified as 340B participants; all others were classified as non-340B. Key measures included charity care as a percentage of operating expenses, Medicaid admission days as a share of hospital days, unreimbursed or uncompensated care, and costs associated with uninsured patients approved for charity care. Welch’s t-tests assessed statistically significant differences in unadjusted mean values. Results Among 3,999 hospitals, 340B hospitals reported lower charity care than non-340B hospitals (2.16% vs 2.82% of operating expenses, P