Editorial; . . . Free Care an Issue

It’s the dirty little secret of the Uncompensated Free Care Pool, which is also part of the health care debate.

A timely report by the state inspector general confirms what many suspected all along – that the $800 million pool “lacks reasonable management systems to control costs, ensure appropriate levels of treatment and safeguard against improper billing.”

The pool is funded by the state, hospitals and insurers. And it’s used to cover the cost of care – usually emergency room care – provided to those otherwise not covered by private insurance, Medicare or Medicaid.

But the I.G. noted that there is so little oversight that hospital charges to the pool for a CAT scan can vary from $359 at one hospital to $4,401 at another.

Boston Medical Center and Cambridge Hospital provide the bulk of free care in the Greater Boston area. For those hospitals, the I.G. found, the pool pays at a higher rate than Medicaid, Medicare or private insurers. While some hospitals receive “only a modest reimbursement for providing free care.”

Unless and until health care reform obviates the need for a free care pool, this one is in desperate need of the kind of controls the I.G. is recommending.