The economic tsunami that struck the country last year swept hundreds of thousands of people out of jobs. In most cases, not only did workers lose their livelihoods, they also lost their health insurance.

Covered or not, when they get sick, they still need medical care care that many doctors and hospitals are providing free of charge.

Most physicians, said Dr. Edward Miller of Lehighton, are compassionate and will do what they can to provide care regardless of whether or not the patient can pay.

"I think there's a time, especially if you have an established patient who has lost their job or their health care," he said. "I think all doctors do that. We try to help out where we can. If people don't have insurance, we try to work things out with them as best we can. And more people are losing insurance."

As rising numbers of people lost their jobs, he saw more and more fail to show up for scheduled tests and appointments.

"Essentially, what they do is cancel their appointments. They are cutting back more in that way just not coming in unless they really, really need to," he said.

"One of the problems when people don't have insurance is that they may not come in until they are very ill. Then, you need to run other tests, or they need to see a specialist. They don't want further testing or a specialist because they can't pay for it. Very commonly, what we do is talk with the hospitals or labs. Our local hospitals are very good in getting the testing done and getting them taken care of," Miller said.

Miller said he knows of many doctors in Carbon County who treat patients out of the goodness of their hearts.

"If physicians know people have been laid off, they just don't send a bill," he said.

They are not alone.

A Nov. 18 report released by the Institute for Good Medicine at the Pennsylvania Medical Society suggests "demand for charitable care provided by physicians increased significantly in the past year, and that their ability to meet the demand may be unsustainable."

According to the Good Medicine 2009 report, 57 percent of Pennsylvania physicians surveyed in a statewide poll say the demand on their time for charitable care has increased. Furthermore, 62 percent say that they've reached an unsustainable level. The 2009 report, conducted among member physicians across all specialties, had a 4.6 percent margin of error.

"Last year, our research indicated a strikingly high level of charitable care provided by Pennsylvania Medical Society members," said Peter Lund, MD, founder of the Institute for Good Medicine. "Even though our physician members are doing more for the uninsured and underinsured, many feel they're reaching their limit."

Lund said that last year's report noted that 80 percent of Pennsylvania Medical Society physicians donate their time and/or resources, for an estimated value of $400 million.

"With the state of the economy, I'm not surprised by this year's findings, and clearly this could signal problems ahead," Lund said.

As it goes for doctors, so it goes for hospitals.

At Blue Mountain Health System's Gnaden Huetten campus, the amount of charitable care and bad debt in 2007 totaled $3,794,588. By 2008, the figure had grown to $4,041,597.

This year, the amount came to $3,281,671 as of early December.

At the Palmerton campus, the figures are even more striking: the combination in 2007 came to $938,745. By 2008, it had grown to $1,419,536. This year, the number stands at $2,047,938.

At St. Luke Miners Memorial Hospital, Coaldale, the numbers stood at $5,557,950 for fiscal year 2009 ($107.3 million for the entire St. Luke's Hospital & Health Network). They crest above the amount for fiscal year 2008, when the figures were $4,326,968 for St. Luke's Miners ($84,472,883 for the health network).

For both hospitals, the figures do not include the array of educational and services provided at little or no cost to the public, such as Blue Mountain's flu shots or St. Luke's screenings.

The services can add up.

"The numbers don't reflect flu shots, free health screenings and education, and we do at least 30-40 of those events a year," said Blue Mountain spokeswoman Lisa Johnson.

Hospitals take a heavy hit from the amounts of uncollected debt and charitable care.

"Charity care and bad debt are components of uncompensated care."said Blue Mountain Health System CFO Larry Moore. "The hospital industry has become very capital-intensive, whether related to inpatient facilities, outpatient facilities, advanced diagnostic equipment, or up-to-date operating and procedure rooms. With an aging population the demand will only continue to increase. Thus our ability to generate capital is more important than ever. However, an increase in uncompensated care has a negative impact on the ability to generate capital. Blue Mountain Health System has seen the percentage of uncompensated care increase to 8.1 percent of net patient revenues during the first four months of (fiscal year) 2010. This compares to 6.9 percent in (fiscal year) 2008 before the down turn in the economy."

But despite the economic burden, officials at both hospitals say their patients are their true bottom line.

"Our goal as the region's health care provider is to keep the community healthy. We strive to do this through screenings, health talks and other educational and community events, but recognize that it's not an immediate solution," said Bill Crossin, president, St. Luke's Miners Memorial Hospital. "As a region that lacks physicians in medical specialties, it's important for us to bring patients the care they need, when they need it. We've taken a proactive step to connect our patients with these medical specialists through telehealth services. The telehealth technology offers us the opportunity to provide specialized medical care to an underserved patient base. We're also utilizing the Miners Loop, a new transportation service, to provide our patients with an easy means of traveling from our Coaldale campus to specialty appointments within St. Luke's Hospital & Health Network."