High levels of uncompensated care impact hospital profitability and may create challenges for rural hospitals at financial risk of closure. We explore 2019 hospital uncompensated care as a percentage of operating expenses and draw comparisons at a state level by Medicaid expansion status and rural classification. We further compare uncompensated care in 2019 to 2014 in rural hospitals by Medicaid expansion implementation timing. We found that, overall, rural hospitals had more uncompensated care than urban hospitals in 2019 (3.81% vs. 3.12%), but there was a larger difference by expansion status (expansion states: 2.55% vs. non-expansion states: 6.28%). In all but seven states, rural hospitals reported higher uncompensated care than urban, and the 14 states with the highest uncompensated care had not expanded Medicaid. We observed that rural hospital uncompensated care in non-expansion states increased between 2014 and 2019, while the most dramatic decrease occurred in late-expansion states.

中文翻译：

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农村医院的无偿护理最为严重，尤其是在非扩张州。

高水平的无偿护理会影响医院的盈利能力，并可能给面临关闭财务风险的乡村医院带来挑战。我们探讨了 2019 年医院无偿护理占运营费用的百分比，并根据医疗补助扩展状况和农村分类在州一级进行比较。我们进一步按医疗补助扩展实施时间比较了 2019 年和 2014 年农村医院的无偿护理。我们发现，总体而言，2019 年农村医院的无偿护理比城市医院多（3.81% vs. 3.12%），但根据扩张状态差异较大（扩张州：2.55% vs. 未扩张州：6.28%） ）。除 7 个州外，所有乡村医院报告的无偿护理均高于城市医院，无偿护理最高的 14 个州尚未扩大医疗补助范围。我们观察到，2014 年至 2019 年间，非扩张州的乡村医院无偿护理有所增加，而扩张后期的州则出现了最大幅度的下降。