The need for free and discounted medical care is escalating across Northeast Ohio, according to the latest tax filings. Hospitals from the giant Cleveland Clinic to smaller players like Parma Community General Hospital have seen drastic jumps in the amounts they spend to provide free care to those who have no insurance. They also have seen jumps in the unpaid portions of bills of those who do have health coverage ? portions that the patients are supposed to pay but can't. "It's really scary," said Bill Ryan, executive director for the Northeast Ohio's hospital advocacy group Center for Health Affairs. Each year, the area's nonprofit health systems are required to file federal tax documents that outline how much money they are earning as well as what they give back to the community. No standard exists for the amount of charity care nonprofit hospitals should provide.