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New Data Underscore Essential Hospitals’ Ongoing Resource Challenges, Unique Role


WASHINGTON — Amid the COVID-19 pandemic’s unprecedented financial and workforce challenges, essential hospitals operated with margins less than half that of other U.S. hospitals and provided a disproportionate amount of charity care, new data show.

An analysis of the more than 300 members of America’s Essential Hospitals — about 5 percent of all U.S. hospitals — shows they delivered 27 percent of all charity care in 2020 and operated with an average margin of 3.2 percent versus 7.7 percent at other hospitals.

In addition to financial challenges, essential hospitals faced capacity and staffing shortages during the height of the pandemic — a third of essential hospitals were operating at more than 100 percent inpatient capacity, and 98 percent had to employ temporary staff.

“The pandemic took a heavy toll on our hospitals and their communities, and the fallout from that continues to this day — especially high labor costs and workforce shortages,” said America’s Essential Hospitals president and CEO Bruce Siegel, MD, MPH. “These hospitals have a unique and irreplaceable role, and they need targeted support to meet their mission of safety net care, lifesaving services, physician training, care coordination, and equity.”

The new data on essential hospitals comes in the association’s annual snapshot of its members, Essential Data 2022: Our Hospitals, Our Patients. The report also found essential hospitals were the site of more than twice as many emergency department visits and nearly three times as many nonemergency outpatient visits as other acute-care hospitals nationally in 2020.

Reflecting their distinct role of caring for low-income and underrepresented populations, 54 percent of essential hospitals’ discharges in 2020 were people of color, and three-quarters were uninsured or covered by Medicaid or Medicare. In the communities essential hospitals serve, 7.5 million people had limited access to healthful food, 370,000 experienced homelessness, 10.8 million had no health insurance, and 15.8 million lived below the poverty line in 2020.

“Essential hospitals occupy a special place in the health care system, due to their experience — and success — helping people and communities overcome social and economic factors that create disparities in health and other inequities,” Siegel said.

In addition to their core role of caring for marginalized populations, essential hospitals provide communities at large with complex, lifesaving services and contribute significantly to local and state economies. In 2020, essential hospitals:

  • operated nearly a third of the nation’s level I trauma centers and 40 percent of all burn care beds;
  • trained an average of 244 physicians per hospital versus 90 at other teaching hospitals; and
  • employed about 3,200 people per hospital and had total expenditures of about $147 billion nationally.

Essential hospitals’ reliance on public payers, such as Medicaid and Medicare; their small share of commercially insured patients; and their disproportionate provision of charity care translates to an average of nearly $63 million per hospital in uncompensated care versus $8.3 million at other U.S. hospitals.

Essential Data 2022: Our Hospitals, Our Patients, is available on the America’s Essential Hospitals website.

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About America’s Essential Hospitals
America’s Essential Hospitals is the leading association and champion for hospitals dedicated to equitable, high-quality care for all, including those who face social and financial barriers to care. Since 1981, America’s Essential Hospitals has advanced policies and programs that promote health, health care access, and equity. We support our more than 300 members with advocacy, policy development, research, education, and leadership development. Communities depend on essential hospitals for care across the continuum, health care workforce training, research, public health and health equity, and other services. Essential hospitals innovate and adapt to lead all of health care toward better outcomes and value. Learn more at

Carl Graziano


About the Author

Dedicated staff at America's Essential Hospitals work together to produce high-quality, reliable content. Please view the about section for more details about staff.

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