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Each year, the charitable burden hospitals take on continues to grow.

That trend is reflected again in this year's Community Investment Report from the Missouri Hospital Association.

Missouri hospitals provided more than $1.5 billion in uncompensated care for patients in 2018 (the latest data available for the report).

The Affordable Care Act mandates hospitals demonstrate their public benefit, said Dave Dillon, MHA vice president of public and media relations.

The report is about hospitals being transparent about how they help improve their communities, Dillon said.

For 2018, Missouri hospitals provided approximately $846.5 million in charity care. Charity care is basically free or discounted care for people under certain income levels.

They also absorbed approximately $658.5 million in "bad debt" — when individuals can't pay for the care they receive.

With bad debt, because more and more people are on high-deductible levels (of $5,000 for example) that they can't pay, their debt may be absorbed by hospitals.

In 2018, Missouri hospitals provided $80 million more in uncompensated care than it had the previous year. Much of the growth — about $50 million — came from uncompensated care, according to the report.

"Over a decade and a half, we've seen (uncompensated care) expand by more than double," Dillon said.

About 15 years ago, when the first report came out, uncompensated care across the state was approximately $700 million.

From year to year, the number of people with employer-sponsored health insurance declines, Dillon said.

"There's a giant hole in coverage in general," Dillon said. "There will always be an uninsured population. There will always be people who sign up for the cheapest policy and don't get the benefit or best coverage."

The report also looks at unpaid costs of treating Medicare and Medicaid patients. In 2018, Missouri hospitals absorbed more than $570 million in unpaid costs for treating Medicare patients and $558 million in unpaid costs for Medicaid patients.

The report not only takes into account the losses that hospitals absorb for their communities, it also looks at investments hospitals make in them.

In 2018, hospitals spent $439 million on education for health professionals and contributed $44 million in donations within their communities.

Additionally, they employed more than 161,000 people in 2018, accounting for $11.3 billion in payroll and benefits.

MHA provides an online consumer data site with information from Missouri hospitals. The searchable site,, is intended to provide information about hospitals' quality, community benefit and economic impact. It is intended to help consumers explore pricing for participating hospitals services, quality of care delivered and how hospitals create value for the communities they serve.

It shows that in 2018, St. Mary's Hospital in Jefferson City provided more than $8.4 million in uncompensated care — $4.4 million for charity care and $4 million for bad debt.

St. Mary's generated $66 million in payroll and benefits and paid in more than $3.6 million in taxes. It showed a loss of approximately $15 million, which was an improvement over two years prior, when losses exceeded $20 million.

The site shows information on quality of care and pricing.

It shows St. Mary's Hospital hospital was about equal with the state average for re-admissions following procedures and fared better than average for items like major bedsores during hospital stays.

Capital Region Medical Center conducted a little more than $12 million in uncompensated care in 2018, about $3.5 million for charity care and $$8.6 for bad debt.

The hospital showed a net income of $5.7 million in 2018.

It also fared about average for re-admissions following procedures.

And it showed about half as many (1.4 per 1,000 discharges) complications from infection following surgery than the state average (3 per 1,000 discharges).

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