The Local Market of Major Teaching Hospitals
June 12, 2023
Teaching hospitals perform three major roles within the medical system: graduate medical education, research, and patient care. The Affordable Care Act, Internal Revenue Service regulations, and other federal initiatives require that teaching hospitals demonstrate a community benefit. Teaching hospitals provide 32 percent of all hospital charity care while only making up 5 percent of hospitals; the markets they serve primarily determine who receives higher levels of uncompensated care.
While most research on teaching hospitals focuses on their functions as regional or national referral centers, teaching hospitals serve an important role as local community hospitals for the surrounding communities. This study sought to describe the local communities served by major teaching hospitals (MTHs). By using data from the Dartmouth Atlas Hospital Service area (HSAs) and US Census Bureau’s 2019 Community Survey 5-Year Estimate Data tables and studying the relation between MTHs (as defined by a hospital with an intern-to-resident bed ratio greater than 0.25 and at least a 100 resident beds) and the local markets they served. The data was further broken down by region and parsed local populations by race, sex, insurance coverage, disability, education, and income.
The analysis found that many of the HSA’s communities were both disadvantaged and advantaged. The data showed that the MTHs served a higher percentage of minorities and patients with Medicare than the average overall US population, two underserved groups. However, they served a smaller portion of the elderly, patients with disability, and Medicaid recipients. Another central contributing data point was that although there was significant geographical variation, the average MTH market falls within the category of “middle income,” meaning a household income between two-thirds and double the median income. Further studies are needed to classify these markets in order to better understand the level of uncompensated and underserved care that these hospitals provide.
