Disproportionate share hospital
A disproportionate share hospital (DSH) is a facility that serves a high proportion of low-income, Medicaid, and uninsured patients. Such hospitals receive supplemental Medicare and Medicaid payments to offset the financial burden of caring for underserved populations.
What is a disproportionate share hospital?
A disproportionate share hospital (DSH) is a facility that treats an unusually high share of low-income, Medicaid, and uninsured patients. The designation reflects the heavier financial burden these hospitals carry compared with peers serving more commercially insured populations.
To help offset that burden, qualifying hospitals receive supplemental payments through Medicare and Medicaid. These additional funds are intended to support continued access to care for underserved communities.
Why do disproportionate share hospital payments matter?
DSH payments help keep safety-net hospitals financially viable so they can continue caring for vulnerable populations who might otherwise lack access. They are an important part of how the system supports care for the uninsured and underinsured.
This is primarily a hospital-level payer and policy mechanism rather than an ambulatory surgery center concern, since the designation and supplemental funding apply to qualifying hospitals. Revenue-cycle professionals encounter it most when working across hospital and outpatient environments.
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