Patient Repayment of US Hospital Bills From 2018 to 2024

Area of Science:

• Health Economics
• Healthcare Management
• Patient Financial Experience

Background:

• Patient cost sharing liability has significantly increased in recent years.
• This rise in out-of-pocket expenses presents financial challenges for households and collection difficulties for healthcare providers.

Purpose of the Study:

• To analyze trends in patient repayment of cost sharing over recent years.
• To examine how repayment rates vary based on patient, hospital, and service characteristics.

Main Methods:

• A cross-sectional study analyzed billing and payment data from 217 US hospitals between 2018 and 2024.
• The study included 30.7 million patient episodes of care for individuals with private insurance and Medicare Advantage.

Main Results:

• Mean patient liability was higher for privately insured individuals ($375.41) compared to Medicare Advantage ($172.50).
• Patient repayment rates for cost sharing declined from approximately 53.9% pre-pandemic to lower levels in recent years.
• Repayment rates were lowest for the largest and smallest bills, and highest for mid-sized bills.

Conclusions:

• Patient cost sharing repayments are incomplete and have decreased over time, contributing to medical debt and revenue shortfalls.
• Findings suggest a need to re-evaluate insurance plan designs and medical debt policies.
• Continued declines in repayment may prompt providers to seek upfront cost sharing payments.