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What percentage of hospital bills do patients usually pay?
Hello! Thank you for your question regarding the percentage of hospital bills patients pay. The short answer is that the total cost of unpaid patient hospital bills was $35.7 billion in 2015, and hospitals are generally able to collect only about 35 percent of the total cost owed by a patient. Based on the average cost and length of a hospital stay in the United States, the average insured patient is paying approximately $846.25 for a single hospital stay. You will see a deep dive of my findings below.
METHODOLOGY
Despite extensive research, I found that specific data on the average cost paid by individual patients towards hospital bills is not available, nor was data on what percent of hospital bills patients default on.
However, while the specific information you requested was unavailable, I was able to research a variety of statistics and facts surrounding the issue of unpaid medical bills which should hopefully provide you with a clearer picture of the landscape. Additionally, I was able to triangulate the requested data based on the available information. Specifically, I was able to identify the total value of all unpaid hospital bills, as well as other data regarding the rising costs of healthcare to both patients and hospitals. Recent years have seen insurance companies paying less while charging more, leaving patients responsible for increasingly higher healthcare costs not only at hospitals, but also with their primary care providers, with specialists, and in pharmacies. That said, the past one to two years has seen a noticeable decrease in the rate of unpaid medical bills, a trend which many experts attribute to the Affordable Care Act.
It is important to keep in mind that the majority of this data was obtained while the Affordable Care Act (ACA) was in place. As President Donald Trump repeals and replaces the ACA, these values and projections are very likely to change.
OVERVIEW
As referenced above, unpaid hospital bills in 2015 alone totaled $35.7 billion in the United States. While the amount itself is quite high, it represents the smallest percent of total hospital expenses - 4.2 percent - in 26 years. Comparatively, during the majority of years between 1990 and 2014, the percentage hovered at around six percent.
In total, from 1990 to 2015 the total cost of unpaid hospital bills reached $704.7 billion, with an annual high of $45.9 billion in 2012. These values account for every outstanding hospital bill, excluding those amounts paid by insurance companies. Ultimately, when patient bills remain unpaid, that cost typically falls back on the hospital or, in some situations, charities aimed at helping patients handle exorbitant medical feels. Broken down by hospital and by patient, the annual cost of uninsured, unpaid medical bills is approximately $900 per patient, per year to every hospital in the United States. Ultimately, two thirds of unpaid hospital debts remain unpaid, largely because hospital billing practices "are not designed to collect small, incremental payments from hundreds or thousands of patients."
RESPONSE AND CALCULATIONS
Viewed on a more individual level, historical trends show that hospitals generally collect around 35 percent of the total bill charged to a patient. Specifically, "for every patient dollar being billed, hospitals have historically failed to collect 65 cents."
Given that the average cost of a one-day stay at a for-profit hospital in the United States is $1,791, this means that patients are paying an estimated $626.85 for just one day in the hospital. These amounts are higher in non-profit hospitals (where the average cost of a one-day stay is $2,289) and government-run hospitals (where the average cost of a one-day stay is $1,878).
Keeping the above numbers in mind, the average length of a hospital stay is 4.5 days, meaning that a patient at a for-profit hospital is likely to be billed is closer to $8,059, with the patient ultimately paying approximately $2,820. These estimates are based on an uninsured patient who is being billed the full cost of their hospital stay.
For insured patients, the average split between insurer and patient is 70-30, meaning that patients are responsible for only 30 percent of the total bill. Based on this average, a patient staying in a for-profit hospital for 4.5 days can expect to be charged an average of $2,417.85 once their insurance has paid the first 70 percent of the bill. Based on that, an insured patient who pays only 35 percent of the total bill would ultimately find themselves paying $846.25.
All said, these two amounts - the cost paid by uninsured patients, and the cost paid by insured patients - average out to an estimated $1,833 per patient, per 4.5 day stay.
These numbers are supported by patients, 20 percent of whom report that they are experiencing difficulty paying medical costs. This number is based on insured Americans, and is even higher - 53 percent - for the uninsured community. Specifically, 31 percent of people who reported struggling with medical bills, indicated that the total bill reached more than $5,000, while 13 percent indicated that their bills totaled $10,000 or more.
SUMMARY
To summarize, the average patient staying 4.5 days in a for-profit hospital pays between $846 and $2,820 depending on whether or not they are insured. Hospitals are generally able to collect an average of 35 percent of what is charged to a patient, leaving 65 percent unpaid. Ultimately, this results in uncompensated care costs that account for approximately 4 to 6 percent of the hospital's annual costs.
Thank you for asking Wonder! Let us know if we can help with anything else.