June 2003

Unintended Consequences: How Federal Regulations and Hospital Policies can Leave Patients in Debt

Carol Pryor and Robert Seifert, The Access Project

A substantial body of research indicates that the uninsured are more likely than the insured to delay or forgo care because of cost, but even the insured may find cost a significant barrier to care. Recent research has documented that, in order to obtain medical care, many individuals are forced into debt, often with serious consequences for themselves and their families.

In one survey, 60 percent of uninsured respondents who received ambulatory care primarily at safety-net facilities said they needed help paying for their medical care, and nearly half (46%) said they owed money to the facility where they received care. The proportion with outstanding bills rose to about two-thirds for those who received care in emergency rooms. In another survey, more than a quarter of families in which one or more members were uninsured reported having to "change their way of life significantly" to pay medical bills, a figure that rose to nearly 40 percent when all family members were uninsured. A 2001 survey found that 10 percent of Medicare beneficiaries reported not being able to pay medical bills, and 12 percent said they had to change their way of life to pay bills.