Oregon Community Benefit Reform Influenced Not-For-Profit Hospitals’ Charity Care And Medical Debt Write-Off

Not-for-profit hospitals are required to provide community benefits to improve the well-being of their communities. However, hospitals' community benefit spending has remained mostly flat despite federal and state regulations intended to increase it. A new Oregon policy takes a multiphase approach to increase not-for-profit hospitals' community investment. In 2020, phase 1 expanded patient financial assistance requirements and medical debt protections. In 2021, phase 2 imposed a hospital-specific minimum community benefit spending floor. Using a nearest-neighbor matching difference-in-differences design and hospital financial data from the period 2016-22, we examined the impact of phase 1 requirements on charity care spending and bad debt. Oregon's patient financial assistance and medical debt protections were associated with higher charity care spending ($423,000 per hospital) and higher levels of bad debt ($846,000 per hospital) by Oregon hospitals relative to control hospitals. It is too soon to understand the effects of minimum community benefit spending floors.