Public Hospital - United States

United States

In the United States, two thirds of all urban hospitals are non-profit. The remaining third is split between for-profit and public. The urban public hospitals are often associated with medical schools. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which is associated with the New York University School of Medicine.

In the U.S., public hospitals receive significant funding from local, state, and/or federal governments. In addition, they may charge Medicaid, Medicare, and private insurers for the care of patients. Poor uninsured patients receive their care for free. Public hospitals, especially in urban areas, have a high concentration of uncompensated care and graduate medical education as compared to all other American hospitals. Public hospitals in America are closing at a much faster rate than hospitals overall. The number of public hospitals in major suburbs declined 27% (134 to 98) from 1996 to 2002. It is thought that the increase in uninsured has drained public hospitals to near bankruptcy. Non-profit rural hospitals were disproportionately represented with high numbers of patients with uncompensated care. Public and non-profit rural hospitals form a large part of the health care safety net for the uninsured and poor underinsured in the U.S.

For-profit hospitals were more likely to provide profitable medical services and less likely to provide medical services that were relatively unprofitable. Government or public hospitals were more likely to offer relatively unprofitable medical services. Not-for-profit hospitals often fell in the middle between public and for-profit hospitals in the types of medical services they provided. For-profit hospitals were quicker to respond to changes in profitability of medical services than the other two types of hospitals.