A descriptive study of hospital uncompensated care in 20 Texas 1115 waiver regional healthcare partnerships

Tochi C Amadi, The University of Texas School of Public Health


Rising uncompensated care costs compounded by the high percentage of uninsured Texas residents presents a challenge for controlling healthcare spending in the state. Texas did not expand Medicaid eligibility under the Affordable care act although faced with high uninsurance and poverty rates, two major drivers of uncompensated care. The section 1115 waiver program was implemented in 2011 to help transform the delivery system and reduce the rising costs in the state. The Delivery System Reform Incentive Payment (DSRIP) component of the waiver provides incentives to providers to transform the delivery system and to improve health outcomes. The objectives of the DSRIP program were to develop a coordinated care delivery system, improve health outcomes and reduce costs. For the purposes of the waiver, Texas was divided into 20 regional healthcare partnerships to develop program plans and foster provider collaboration. Four different categories of projects were designed under the program including infrastructure development, program redesign, quality improvement and population-focused measures. The objective of this study is to assess changes in hospital uncompensated care during part of the period of the waiver implementation, between 2011 and 2014. Hospital uncompensated care was studied at three different levels of aggregation, the statewide level, tier level and regional healthcare partnership level, both as raw dollar values and as a percentage of net revenues. Statewide, uncompensated increased during the first 3 years but slowed between 2013 and 2014. More fluctuations were observed at the tier and RHP levels. Additional data for the last two years of the waiver is needed to determine if the trends in costs continue to slow. Multiple factors may contribute to the fluctuations in uncompensated care seen, including changes in hospital funding streams, 1115 waiver activities, and changes in the healthcare insurance marketplace. Further studies are required to appropriately isolate the impact of the waiver program from other factors that potentially impact uncompensated care.

Subject Area

Public health

Recommended Citation

Amadi, Tochi C, "A descriptive study of hospital uncompensated care in 20 Texas 1115 waiver regional healthcare partnerships" (2016). Texas Medical Center Dissertations (via ProQuest). AAI10250936.