Across the U.S., essential hospitals—those providing care to underserved and uninsured populations—struggle to stay afloat. These institutions, accounting for only 5% of hospitals, yet deliver more than a quarter of all charity care in spite of a pattern of underfunding.
A 2023 report by America’s Essential Hospitals revealed that essential hospitals had an average operating margin of -8.6%, while other hospitals are at -1.4%. This financial reality threatens the very existence of safety-net hospitals, which serve as lifelines for millions of Americans struggling with healthcare debt. Yet, Nashville General Hospital (NGH) is proving that public hospitals can survive.
Over the past eight years, we’ve transformed into a sustainable institution—recently experiencing our most successful financial year in more than a quarter of a century—while serving an expanding community. How did we achieve this? Through innovative, equity-centered initiatives that save money, expand patient access, and champion health equity without compromising care quality.
What does a healthier, more equitable future look like? The future of the American health system lies outside the walls of the hospital and within the communities they serve. For public hospitals, that means focusing not just on treating acute illness but on improving overall population health focused on increasing access to care and addressing socio-economic barriers.
At NGH, our Nashville Healthcare Incentive Program is a prime example of expanding access to affordable care. By including city, state, and utility employees, we’ve offered new populations access to health services with $0 copayments and $0 deductibles. This program saves individuals up to $4,000 in healthcare costs, ensuring that more people receive the care they need without being threatened by excessive debt.
Our Health Equity Model complements this by addressing social determinants of health—such as food insecurity through a food as medicine strategy delivered in our Food Pharmacy. By providing patients with healthy, medically tailored food products, we’re not just fighting against food deserts—we’re directly improving community health and reducing conditions that contribute to repeat hospitalizations.
Addressing these root causes reduces strain on emergency rooms and improves long-term patient outcomes. This approach doesn't just treat symptoms; it aims to resolve the systemic issues that contribute to poor health.
