Analysis of the Joint Distribution of Disproportionate Share Hospital Payments. Summary of Distribution of Total DSH Payments


Table 4.4. 
Summary of Distribution of Total FY1998 DSH Payments *

Category No. of
Actual Medicare DSH Payments 
Medicaid DSH Payments 
($ mill)
Total DSH Payments 
($ mill)
Total Number of Hospitals1 8,868      
Hospitals Included in the Analysis File2 6,837      
Hospitals with estimated DSH payments
Specific Identified Hospitals 5,534 4,825 13,120 17,946
% of Total   100.0% 87.3% 90.4%
Specific Unidentified Hospitals3 104 0 278 278
% of Total   0.0% 1.8% 1.4%
Unidentified DSH Distribution4 ? 0 1,632 1,632
% of Total   0.0% 10.9% 8.2%
Total DSH Payments   4,825 15,029 19,855

Table 4.4 summarizes the overall results of combining the Medicare hospital-specific estimates with the hospital-specific distribution of FY1998 Medicaid funds reported by the States. The combined file has 5,638 hospitals with identified DSH payments (Column B). We estimate total DSH payments for FY1998 in the amount of $19.855 billion, with the Medicare share of $4.825 billion and Medicaid share of $15.03 billion.

Of total DSH payments, 9.6 % are attributable to unidentified Medicaid DSH payments. Because we do not know most characteristics of the hospitals receiving unidentified payments, we exclude them from the analysis in summaries of payments by classes of hospitals. However, one characteristic that we do know about these payments is their regional distribution (Table 4.5) Compared to the regional distribution of total Medicaid DSH payments, the unidentified funds are more concentrated in the Middle Atlantic (41.9% vs. 22.6%), South Atlantic (22.7% vs. 12.9%) and East South Central (18.4% vs. 3.5%) regions and rarely occur in the Pacific (0.1% vs. 18.4%) and West South Central regions. This distribution of unidentified Medicaid DSH payments has implications for our analysis of DSH payments by hospital classes. To the extent there are there are systematic differences in the types of hospitals across regions, the distribution of total DSH payments by hospital classes inTables 4.6 and 4.7 will be affected.

Medicaid DSH Payments by Region

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