Payor mix at nonprofit vs for-profit hospitals

Hospital payor mix, such as commercial insurance plans, and government programs, such as Medicare and Medicaid, provide insight into a hospital’s financial performance and patient population.

What is the payor mix of a hospital?

In the Definitive Healthcare HospitalView product, payor mix is a proprietary calculation based on revenues, charges, discharges, and patient days from different medical insurance payors.

Using this data, we can estimate the share of revenue sources to derive individual hospital payor mixes. For example, if we know a hospital’s total patient revenue is $100 million, its Medicare revenue is approximately $25 million, and its Medicaid revenue is approximately $10 million, we could calculate a 25% Medicare, 10% Medicaid, and 65% private/self-pay/other payor mix.

According to our data, average hospital payor mix in the U.S. breaks down as follows:

• Private/self-pay/other 56.5%
• Medicare 35.6%
• Medicaid 9.4%

This Healthcare Insight reviews data for more than 5,900 U.S. hospitals and compares the results by the hospital’s profit status. The figures are aggregated from the most recent 12-month interval tracked in our database and updated from the Medicare Cost Report.

What are the different types of hospital profit statuses?

In HospitalView, we track three main types of hospital ownership: governmental, proprietary, and voluntary nonprofit. Governmental and voluntary nonprofit ownerships are considered non-profit hospitals while proprietary hospitals are for-profit.

How does payor mix compare at nonprofit and for-profit hospitals?

Payor mix by nonprofit hospitals and for-profit hospitals varies most in that for-profit have a higher private/self-pay payor mix and a lower Medicare payor mix.